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Review
. 2019 Oct 7;4(10):585-594.
doi: 10.1302/2058-5241.4.180067. eCollection 2019 Oct.

Culture-negative periprosthetic joint infections

Jeya Palan  1 , Ciaran Nolan  1 , Kostas Sarantos  1 , Richard Westerman  1 , Richard King  1 , Pedro Foguet  1
Affiliations
Review

Culture-negative periprosthetic joint infections

Jeya Palan et al. EFORT Open Rev. .

Abstract

Culture-negative periprosthetic joint infections (CN-PJI) pose a significant challenge in terms of diagnosis and management. The reported incidence of CN-PJI is reported to be between 7% and 15%.Fungi and mycobacterium are thought to be responsible for over 85% of such cases with more fastidious bacteria accounting for the rest.With the advent of polymerase chain reaction, mass spectrometry and next generation sequencing, identifying the causative organism(s) may become easier but such techniques are not readily available and are very costly.There are a number of more straightforward and relatively low-cost methods to help surgeons maximize the chances of diagnosing a PJI and identify the organisms responsible.This review article summarizes the main diagnostic tests currently available as well as providing a simple diagnostic clinical algorithm for CN-PJI. Cite this article: EFORT Open Rev 2019;4:585-594. DOI: 10.1302/2058-5241.4.180067.

Keywords: Dithiothreitol; alpha-defensin; culture-negative periprosthetic joint infection; interleukin 6; leucocyte esterase; next generation sequencing; polymerase chain reaction; sonication.

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Conflict of interest statement

ICMJE Conflict of interest statement: RW reports an educational contract for teaching on Exeter Hip Courses for Stryker Europe outside the submitted work. RK reports consultancy and education activities for Corin Group PLC; employment by the NHS as a place of clinical practice; payment for lectures on annual course for Heraeus; payment for development of educational presentations for Corin Group PLC; and accommodation and travel expenses provided for two educational courses for Stryker, all outside the submitted work. PF reports consultancy for Microport, Corin, Zimmer/Biomet, MBA, 3M; payment for lectures including service on speakers bureaus for Microport, Corin, 3M; payment for development of educational presentations for Corin and 3M; and travel/accommodations/meeting expenses unrelated to activities listed for Corin, MBA and3M, all outside the submitted work. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
MicroDTTect analysis bag (photo courtesy of Heraeus Medical GmbH).
Fig. 2
Fig. 2
Diagnostic algorithm for culture-negative periprosthetic joint infection (PJI). Note. THR, Total Hip Replacement; TKR, Total Knee Replacement; CRP, C-Reactive Protein; ESR, Erythrocyte Sedimentation Rate; WCC, White Cell Count; Hx, History.
See this image and copyright information in PMC

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