Diagnosis of periprosthetic joint infections of the hip and knee.
No preferred test for diagnosis of periprosthetic joint infection exists, and the algorithm for the workup of patients suspected of infection remains unclear. The work group evaluated the available literature to determine the role of each diagnostic modality and devise a practical algorithm that allows physicians to reach diagnosis of periprosthetic joint infection. Ten of the 15 recommendations have strong or moderate evidence in support. These include matters involving erythrocyte sedimentation rate and C-reactive protein level testing, knee and hip aspiration, and stopping the use of antibiotics prior to obtaining intra-articular cultures. The group recommends against the use of intraoperative Gram stain but does recommend the use of frozen sections of peri-implant tissues in reoperation patients in whom infection has not been established, as well as multiple cultures in reoperation patients being assessed for infection. The group recommends against initiating antibiotic treatment in patients with suspected infection until after joint cultures have been obtained, but recommends that prophylactic preoperative antibiotics not be withheld in patients at lower probability for infection.
Rush University Medical Center, Chicago, IL, USA.
Craig
C
Della Valle
Javad
J
Parvizi
Thomas W
TW
Bauer
Paul E
PE
Dicesare
Richard Parker
RP
Evans
John
J
Segreti
Mark
M
Spangehl
William C
WC
Watters
Michael
M
Keith
Charles M
CM
Turkelson
Janet L
JL
Wies
Patrick
P
Sluka
Kristin
K
Hitchcock
D000465:Algorithms; D019072:Antibiotic Prophylaxis; D044963:Biopsy, Fine-Needle; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003952:Diagnostic Imaging; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000188:drug therapy; D012086:Reoperation
D002097:C-Reactive Protein