Joint aspiration for diagnosis of chronic periprosthetic joint infection: when, how, and what tests?

Abstract

Diagnosing chronic periprosthetic joint infection (PJI) requires clinical suspicion in combination with both serological and synovial fluid tests, the results of which are generally applied to validated scoring systems or consensus definitions for PJI. As no single “gold standard” test exists, the diagnosis becomes challenging, especially in the setting of negative cultures or equivocal test results. This review aims to address the workup of chronic PJI and considerations for clinical evaluation to guide treatment. Following aspiration of the joint in question, a multitude of tests has been developed in an attempt to assist with diagnosis, including cell synovial white blood cell count, gram stain, cultures, leukocyte esterase, alpha-defensin, synovial C-reactive protein, multiplex polymerase chain reaction, next-generation sequencing, and interleukins. Each test has advantages and disadvantages and should be used in conjunction with the overall clinical picture to guide further clinical evaluation and treatment in this complex patient population.

How Useful Is Preoperative Aspiration before Revision of Unicompartmental Knee Prostheses Because of Osteoarthritis in the Other Compartments?

“…Barrack et al analyzed 78 cases of aspiration in order to detect PJI after TKA and showed a sensitivity of 65.4% and a specificity of 96.1% [23]. By performing several tests simultaneously (C-reactive serum level, leukocyte in serum culturing, leukocyte count in the aspirate, alpha-defensin determination), a very high accuracy can be achieved [24].…”

Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

“…The diagnostic algorithm used in this retrospective study has been elaborated according to the SA/PJI diagnostic criteria as presented by the 2018 International Consensus Meeting for Periprosthetic Joint Infections [ 25 ] and the European Bone and Joint Infection Society [ 17 ]. The algorithm has been completed by the implementation of modern, synovial fluid molecular testing technologies that have been recently recommended by multiple authors [ 5 , 12 , 22 , 23 , 26 ].…”

Current Status and Perspectives of Diagnosis and Treatment of Periprosthetic Joint Infection

“…Unlike serology, joint fluid detection is distinct as serum markers can be influenced by acute or chronic inflammatory diseases in various organs and systems of the body, whereas inflammatory analysis of joint fluid, owing to its limited fluidity and containment within the joint capsule, offers a truer reflection of the local inflammatory condition ( Figure 1C ). 29 Preoperative synovial fluid aspiration in patients with suspected infections allows for the detection of leukocyte count and polymorphonuclear cell percentage, as well as pathogen culture. 30 , 31 This improves diagnostic accuracy and provides essential information for formulating targeted treatment plans.…”