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Review
. 2018 Sep;11(3):428-438.
doi: 10.1007/s12178-018-9513-0.

Current Recommendations for the Diagnosis of Acute and Chronic PJI for Hip and Knee-Cell Counts, Alpha-Defensin, Leukocyte Esterase, Next-generation Sequencing

Karan Goswami  1 , Javad Parvizi  1 , P Maxwell Courtney  2
Affiliations
Review

Current Recommendations for the Diagnosis of Acute and Chronic PJI for Hip and Knee-Cell Counts, Alpha-Defensin, Leukocyte Esterase, Next-generation Sequencing

Karan Goswami et al. Curr Rev Musculoskelet Med. 2018 Sep.

Abstract

Purpose of review: Despite significant progress in recent years, the diagnosis of periprosthetic joint infection (PJI) remains a challenge and no gold standard test exists. A combination of serological, synovial, microbiological, histological, and radiological investigations is performed that are expensive, often invasive, and imperfect. Novel biomarkers and molecular methods have shown promise in recent years. The purpose of this review is to provide an update about the diagnostic recommendations for PJI and cover a selection of emerging diagnostic tools.

Recent findings: Recent literature highlights a new evidence-based definition for diagnosing hip and knee PJI that shows excellent performance on formal external multi-institutional validation. There is also increasing evidence to support the measurement of selected biomarkers in serum and synovial fluid, such as alpha-defensin, D-dimer, and interleukin-6. Finally, the emerging utility of next-generation sequencing for pathogen identification is discussed. In summary, we describe current recommendations and emerging tests for the diagnosis of PJI. Residual limitations and directions for future research are also discussed.

Keywords: Alpha-defensin; Diagnosis; IL-6; Leucocyte esterase; Next-generation sequencing; Periprosthetic joint infection.

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Conflict of interest statement

Conflict of Interest

Dr. Parvizi reports grants, royalties, stocks, and/or consultancy with the following entities: Alphaeon, Ceramtec, Ceribell, ConvaTec, Corentec, Cross Current Business, Datatrace, Elsevier, Ethicon, Heron, Hip Innovation Technology, Intellijoint, Invisible Sentinel, JayPee, Joint Purification Systems, MDValuate, MicrogenDx, Parvizi Surgical Innovations, Physician Recommended Nutriceuticals, PRN-Veterinary, SLACK, Tenor, Tissue Gene, Wolters Kluwer, and Zimmer, outside of the submitted work.

Dr. Courtney is a consultant for Hip Innovation Technology, outside of the submitted work.

Dr. Goswami has no conflicts of interest to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
ICM algorithm for diagnosing PJI (Reprinted with permission from “Diagnosis of Periprosthetic Joint Infection.” Journal of Orthopaedic Research. John Wiley and Sons Publishing Company; 2014, p. 78. License number 4332751175802)
Fig. 2
Fig. 2
The 2018 validated and score-based ICM definition for PJI [15] (Reprinted with permission from “The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria.” The Journal of Arthroplasty. Elsevier; 2018; License Number 4332741333898)
See this image and copyright information in PMC

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