Diagnosis of Periprosthetic Joint Infection

Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty

“…The specificity of PCR analysis is reported to vary significantly (0%-100%). 23,52 Currently, PCR analysis is recommended only for cases with high clinical suspicion but negative cultures or other diagnostic testing. 52 Sonicate fluid PCR has been shown to have similar sensitivities and specificities to sonicate fluid culture.…”

“…29,52 Technetium Tc 99m bone scan is sensitive for identifying a failed arthroplasty but cannot differentiate between infection and aseptic failure. Neither periprosthetic uptake patterns nor performance of the test as a 3-phase study significantly improves the accuracy, which is only about 50% to 70%.…”

“…Routine sonication of prosthetic explants is currently not recommended because of the time and resources demanded by the procedure. 52 Its use is currently limited to those centers that have equipment availability, and it should be used only for suspected or proven prosthetic joint infection in which a preoperative aspiration does not yield a positive culture and antibiotics have been administered within the previous 2 weeks. 52 …”

“…In lower extremity periprosthetic infection, cutoff values of >3000/mm 3 for the WBC count and >80% for the PMN percentage have been used. 52 Currently, there is no consensus on the cutoff values for PSI. These values are further complicated in the setting of inflammatory arthritis as this has been suspected to cause the serum and synovial inflammatory markers to be less accurate for diagnosis of periprosthetic joint infection.…”

“…23,52 With the long culture time of P. acnes, PCR would allow a more rapid identification of the organism. However, the high number of false-positive results precludes its use as a screening test.…”