The Journal of Bone and Joint Surgery; Current Concepts Review; August 5, 2020; 102 (15): 1366

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.