Diagnosis of Infected Total Knee: Findings of a Multicenter Database

Abstract

Although total knee arthroplasty (TKA) is an effective and successful procedure, the outcome is occasionally compromised by complications including periprosthetic joint infection (PJI). Accurate and early diagnosis is the first step in effectively managing patients with PJI. At the present time, diagnosis remains dependent on clinical judgment and reliance on standard clinical tests including serologic tests, analysis of aspirated joint fluid, and interpretation of intraoperative tissue and fluid test results. Although reports regarding sensitivity and specificity of all diagnostic tests in the literature are abundant,

Synovial Fluid Biomarkers for Periprosthetic Infection

“…The recent literature has highlighted the need for improved diagnostics as evidenced by the number of studies attempting to identify the best combination of laboratory tests predicting periprosthetic infection [3,4,9,[14][15][16]. Additionally, new methods of diagnosis such as PCR [12,18], biofilm detection [17,20], and cultures augmented by implant ultrasound [19] have been described and evaluated for diagnostic purposes.…”

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

“…A diagnosis of chronic prosthetic knee infection, at more than 6 weeks after TKA, [8,40,54,71,77,93], defined by at least three of the following, was the inclusion criteria (Table 1): (1) unexplained pain with no radiographic evidence of implant malpositioning; (2) 10 mg/L or greater C-reactive protein (CRP) without preexisting inflammatory joint disease [4,75,86]; (3) 30 mm/hour or greater erythrocyte sedimentation rate (ESR) without preexisting inflammatory joint disease [4,75,86]; (4) radiographic implant loosening and/or periosteal osteogenesis and/or progressive nonfocal osteolysis without implant malpositioning [90]; (5) sinus or fistula communicating with prosthesis; (6) abnormal leukocytes labeled technetium-99 m bone scan (LeukoScan 1 , Immunomedics GmbH, Darmstadt, Germany) [61]; (7) a positive culture of synovial fluid collected preoperatively; (8) five or more polymorphonuclear cells in at least five highpower fields in periprosthetic tissue samples, collected on removal of primary implant [9,32,91]; (9) a positive synovial fluid cell count (more than 2000 polymorphonuclear cells with greater than 64% polymorphonuclear leukocytes) without preexisting inflammatory joint disease [75,91]. A high American Society of Anesthesiologists (ASA) score [59] excluded four patients.…”

“…Infection was considered to have recurred if at any evaluation patients had at least two of the following: (1) unexplained pain and discomfort with no implant malpositioning observed on radiographs; (2) CRP of 10 mg/L or greater without preexisting inflammatory joint disease [4,75,86]; (3) ESR of 30 mm/hour or greater without preexisting inflammatory joint disease [4,75,86]; (4) radiographic evidence of implant loosening, periosteal bone formation, and/or progressive nonfocal osteolysis without malpositioning [90]; or (5) a sinus tract or fistula communicating with the prosthesis.…”

Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection

“…To address this issue, the Musculoskeletal Infection Society (MSIS) has recommended criteria to better define and diagnose PJI, criteria that underwent a modification during the 2013 International Consensus Meeting (ICM) on PJI [18,21]. Proper diagnosis of PJI relies on a detailed patient history, physical examinations, serologic tests, and radiologic assessments [1,20,22]. Additionally, isolation of the microorganism is imperative for proper diagnosis and successful treatment of the patient with PJI [18,22].…”