April 2016

Diagnosis for PJI – Prosthetic Joint Infection

Definitive diagnosis of PJI can be challenging without an obvious draining sinus that communicates with the prosthesis. Listed below are laboratory values that are considered definitive evidence and supportive evidence of PJI.

-Identical microorganisms cultured from 2 or more cultures (Musculoskeletal Infection Society [MIS], International Consensus Meeting [ICM], Infectious Diseases Society of America [IDSA]
-Purulence surrounding the prosthesis (IDSA)

-Purulence surrounding the prosthesis (MIS)
-Acute inflammation upon histological exam (MIS, ICM, IDSA)
-Single culture with any organism (MIS), (ICM)
-Single culture with virulent organism (IDSA)
-Elevated synovial fluid leukocyte count (MIS), (ICM)
-Elevated synovial fluid neutrophil percentage (MIS), (ICM)
-Elevated serum ESR and CRP values (MIS), (ICM)

Outlined by:
Tande and Patel. 2014.Prosthetic Joint Infection. Clinical Microbiology Reviews. Volume 27, number 2, pp 302-345.

Submitted by:
John R. Dorris III, MD
Athens Bone and Joint
Athens, GA