How is a periprosthetic joint infection (PJI) diagnosed in the presence of adverse local tissue reaction (ALTR)?

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 fl\uid for a manual synovial fl uid white blood cell (WBC) count, diff erential 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 fl uid biomarkers in the diagnosis of PJIs in the presence of ATLRs.
LEVEL OF EVIDENCE

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

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