What are the diagnostic criteria for elbow periprosthetic joint infection (PJI)? (Clinical criteria, radiographic criteria, intraoperative findings, pathology, cultures and serum biomarkers.)

What are the diagnostic criteria for elbow periprosthetic joint infection (PJI)? (Clinical criteria, radiographic criteria, intraoperative findings, pathology, cultures and serum biomarkers.)

Authors: Jonathan Barlow, Joaquin Sanchez-Sotelo
RECOMMENDATION: The following three parameters provide a defi nitive diagnosis of elbow PJI:
• A sinus tract that is communicating with the prosthesis (Strength: Strong)
• Isolation of identical pathogens from two or more separate cultures (tissue or articular fluid) obtained under sterile conditions (Strength: Strong)
• Presence of intra-articular pus (Strength: Consensus)
The following criteria are concerning for infection and should be considered in aggregate (Strength: Limited):
• Warmth, redness, swelling of the elbow
• Elevated serum infl ammatory markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)) – except in cases of infl ammatory arthropathies
• Elevated synovial white blood cell (WBC) count
• Elevated synovial polymorphonuclear percentage
• Isolation of organism from one sample (tissue or articular fl uid)
• Histologic evidence of acute infl ammation
• Early unexpected component loosening
• Endosteal scalloping, rapid progressive loosening on radiographs
LEVEL OF EVIDENCE: Consensus
DELEGATE VOTE: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

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