[Diagnosis of Periprosthetic Joint Infections]

Area of Science:

• Orthopedics
• Infectious Diseases
• Medical Diagnostics

Background:

• Diagnosing periprosthetic joint infection (PJI) presents challenges, especially with biofilm-forming bacteria or less aggressive pathogens.
• No single diagnostic test offers complete accuracy for PJI detection.

Purpose of the Study:

• To review current diagnostic methods for periprosthetic joint infection (PJI).
• To highlight the importance of accurate PJI diagnosis for treatment selection and patient outcomes.

Main Methods:

• Utilizes standardized PJI definitions (2011) integrating clinical signs, serum markers, joint aspiration, microbiological cultures (synovial fluid, tissue, sonication), histology, and imaging.
• Evaluates preoperative tests like synovial leukocyte count and %PMN, intraoperative tissue sampling, and implant sonication.
• Considers emerging molecular techniques like next-generation sequencing (NGS).

Main Results:

• Preoperative synovial leukocyte count and %PMN are highly accurate.
• Intraoperative tissue histology and cultures are reliable, though cultures can have false negatives.
• Synovial fluid culture sensitivity is limited, but sonication and NGS show promise.

Conclusions:

• Accurate PJI diagnosis relies on a multimodal approach combining various tests.
• Standardized definitions and advanced techniques like NGS improve diagnostic capabilities.
• Timely and precise diagnosis is essential for optimal patient management and joint preservation.