Elsevier

The Journal of Arthroplasty

Volume 26, Issue 8, December 2011, Pages 1136-1138
The Journal of Arthroplasty

Brief Communication
New Definition for Periprosthetic Joint Infection

https://doi.org/10.1016/j.arth.2011.09.026Get rights and content

Abstract

Diagnosis of periprosthetic joint infection (PJI) remains a real challenge to the orthopedic community. Currently, there is no single standard definition for PJI. This communication presents the diagnostic criteria that have been proposed by a workgroup convened by the Musculoskeletal Infection Society. The diagnostic criteria were developed after the evaluation of available evidence. The role of every diagnostic test was examined, and the literature was reviewed in detail to determine the threshold for each test. It is hoped that the proposed definition for PJI will be adopted universally, bringing standardization into a field that has suffered extensive variability and heterogeneity.

Section snippets

Definition of PJI

Based on the proposed criteria, a definite PJI exists when:

  • (1)

    there is a sinus tract communicating with the prosthesis; or

  • (2)

    a pathogen is isolated by culture from 2 or more separate tissue or fluid samples obtained from the affected prosthetic joint; or

  • (3)

    when 4 of the following 6 criteria exist:

  • (a)

    elevated serum erythrocyte sedimentation rate and serum C-reactive protein (CRP) concentration,

  • (b)

    elevated synovial white blood cell count,

  • (c)

    elevated synovial polymorphonuclear percentage (PMN%),

  • (d)

    presence of

Microbiologic Testing

It is imperative that tissue for culture be obtained from representative periprosthetic tissue or fluid. To limit the risk of contamination, each sample should be taken with separate, sterile instruments. The definition of phenotypically identical organisms should be based on phenotypic similarities and in vitro antimicrobial susceptibility testing because confirmation of genetic identity is not routinely performed on clinical isolates. It is recommended that at least 3 and no more than 5

Acknowledgments

We would like to thank Sandra Berrios-Torres, MD; Ryan Fagan, MD, MPH; and Teresa C. Horan from the Centers for Disease Control and Prevention for their valuable input and assistance in the process of reaching these criteria.

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The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.09.026.

Parts of this article have been reprinted from Clin Orthop Relat Res, vol 469, 2011, p. 2992, New definition for periprosthetic joint infection: from the workgroup of the Musculoskeletal Infection by Parvizi J, Zmistowski B, Berbar, EF, et al, © The Association of Bone and Joint Surgeons 2011, with kind permission of Springer Science and Business Media.

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