Diagnosing prosthetic joint infection: traditional and contemporary techniques

Abstract

: Prosthetic joint infection (PJI) has been recognised as a devastating complication for as long as arthroplasty has been performed. Despite this, there is still no universally agreed standard within either PJI literature or clinical practice for the diagnosis of infection following joint arthroplasty. Recently, however, significant efforts have been made by different specialist musculoskeletal societies to move towards this goal. This paper reviews the history of the diagnosis of PJI, examines the current debate on diagnostic criteria and the limitations of a lack of consensus on infection research, clinical practice, and joint registry data. Based on the current situation, we propose that until there is a consensus on existing algorithms for diagnosis, there is need to implement a “minimum standard set of PJI diagnostics” locally by each national orthopaedic/ trauma association (focusing on those tests which are included in every specialist musculoskeletal society’s recommended list). Since there is still variation not only internationally but at national and sometimes at local level regarding standardisation of PJI testing, a smaller number of universally accepted PJI tests which are implemented and professionally monitored by national musculoskeletal societies will likely to result in significant improvement in PJI management in the short term, whilst the debate regarding the best criteria is still ongoing and is likely to continue for some time. 7