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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