Value of Preoperative Investigations in Diagnosing Prosthetic Joint Infection: Retrospective Cohort Study and Literature Review

Abstract

The diagnosis of a prosthetic joint infection is difficult, but crucial for appropriate treatment. Scintigraphy with specific markers for infection (labelled white cells or immunoglobulin-G) has been reported as a more reliable diagnostic tool than clinical assessment (fever, fistula), laboratory studies (polynuclear neutrophil count, erythrocyte rate sedimentation, and C-reactive protein), and preoperative aspiration. In the first part of this study, we retrospectively reviewed 230 patients admitted with a suspected prosthetic joint infection, and examined the validity of the different diagnostic tools for the group as a whole and for subgroups according to the Coventry classification. In the second part, we reviewed 35 articles about preoperative evaluation of infection in prosthetic joints and compared them to our findings. Our study indicates that C-reactive protein and joint aspiration are the most useful tools to diagnose prosthetic joint infection even in situations of chronic infection (Coventry type II).

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: A Review of Risk Factors and Current Approaches to Diagnosis and Management

“…While patients with connective tissue disorders were included in these studies, they were not analyzed independently from osteoarthritis. One retrospective review of 228 suspected PJIs found that CRP was more sensitive than ESR when infection was defined by a minimum of one positive intraoperative culture for virulent organisms such as streptococci species or Gram-negative bacterium or three positive intraoperative cultures for less virulent organisms like coagulase-negative staphylococci or propionibacterium species [4].…”

Inflammatory response in 85 patients with loosened hip prostheses: A prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening

“…Bernard et al (2004) retrospectively reviewed 230 patients with suspected prosthetic joint infections (hip or knee) and reviewed 33 articles dealing with preoperative evaluation of infection in prosthetic joints. They concluded that CRP and joint aspiration are the most useful tools to diagnose prosthetic joint infections, even in situations of chronic infection.…”

Percutaneous interface biopsy in dry-aspiration cases of chronic periprosthetic joint infections: A technique for preoperative isolation of the infecting organism

“…This technique carries some limitations. First, studies of preoperative joint aspiration show a wide variation in sensitivity values, ranging between 0.11 and 1.00 [6][7][8]. Low sensitivity values for fluid aspirates in chronic PJI are partly attributable to the fact that most micro-organisms in such infections grow in biofilms, attached to the implant surface (sessile bacteria).…”

“…Currently, the most-used technique for reaching a bacteriological diagnosis is evaluation of fluid aspirated from the joint [6,7]. This technique carries some limitations.…”

“…This can be difficult to accomplish in cases of low-grade chronic infection, due to factors such as a paucity of organisms in the joint fluid, highly fastidious growth, the biofilm nature of PJI, and the impact of any earlier antibiotic therapy. Sampling factors such as time delay, anaerobic environment or improper laboratory practice may also play a part [1,2,[5][6][7][8][9].…”