The Journal of Bone and Joint Surgery - Current Concepts Review: 19 May 2020 - Volume 102 - Issue 15 - p. 1366-1375

Diagnosis of Periprosthetic Infection

Wasterlain, Amy S., MD; Goswami, Karan, MD; Ghasemi, S. Ali, MD; Parvizi, Javad, MD, FRCS

Hip Knee

There is no absolute test for the preoperative diagnosis of periprosthetic joint infection (PJI); thus, clinical practice relies on a combination of supportive tests and criteria.
Novel serum and synovial tests have improved our ability to diagnose PJI. The 2018 evidence-based algorithm for PJI diagnosis provides weighted scores for serum markers, as well as synovial markers, to facilitate diagnosis when major criteria such as positive cultures or a sinus tract are not present.
Culture-independent technologies such as next-generation sequencing can facilitate pathogen identification, particularly in the setting of culture-negative PJI.
Despite recent developments, PJI diagnosis remains challenging and warrants further innovation.