Authors: Carlos Bracho, Rafael J. Sierra, Rene Mihalič, Craig J. Della Valle, Linda Suleiman

RECOMMENDATION: The diagnosis of PJI in the presence of an ALTR is challenging as many of the commonly used tests for diagnosis (including the appearance of the surgical site) can be falsely positive. An aggressive approach to preoperative evaluation including an aspiration of the hip joint (sending the fluid for a manual synovial fluid white blood cell (WBC) count, differential and culture) is recommended. Testing the synovial fluid for leukocyte esterase (LE) appears as a feasible, inexpensive and reliable test for the diagnosis of PJIs in ALTRs. There is no supporting evidence for other synovial fluid biomarkers in the diagnosis of PJIs in the presence of ATLRs.

LEVEL OF EVIDENCE: See chart below in PDF

DELEGATE VOTE: Agree: 84%, Disagree: 7%, Abstain: 9% (Super Majority, Strong Consensus)

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