Diagnosis of Periprosthetic Joint Infection Following Hip and Knee Arthroplasty




The diagnosis of periprosthetic joint infection (PJI) following total hip arthroplasty and total knee arthroplasty has been one of the major challenges in orthopedic surgery. As there is no single absolute test for diagnosis of PJI, diagnostic criteria for PJI have been proposed that include using several diagnostic modalities. Focused history, physical examination, plain radiographs, and initial serologic tests should be followed by joint aspiration and synovial analysis. Newer diagnostic techniques, such as alpha-defensin and interleukin-6, hold great promise in the future diagnosis of equivocal infections.




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    In the case of indolent infections, newer diagnostic modalities, such as alpha-defensin or interleukin-6, show great potential to complement current techniques in future clinical practice.




  • •

    In the case of indolent infections, newer diagnostic modalities, such as alpha-defensin or interleukin-6, show great potential to complement current techniques in future clinical practice.








    • Also of note, The Society of Unicondylar Research and Continuing Education suggested that these criteria, including ESR and CRP threshold values, can also be used in suspected PJI following unicompartmental knee arthroplasty (UKA), but that the aspiration biomarker thresholds in UKA can deviate significantly from the ICM values for TKA.








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    Increased duration of surgery




    • Subperiosteal reaction




    ESR has no diagnostic utility in acute PJI (<6 weeks)






    In cases of bloody joint aspirations, 1.5 mL of synovial fluid should be transferred to a microcentrifuge tube, loaded into a minicentrifuge symmetrically, and spun for 2 to 3 minutes at maximum speed (ideally ≥6600 revolutions per minute). The synovial fluid separates as the supernatant, which can be needle aspirated and transferred for accurate LE testing.












    References



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    Feb 23, 2017 | Posted by in ORTHOPEDIC | Comments Off on Diagnosis of Periprosthetic Joint Infection Following Hip and Knee Arthroplasty

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