The Challenge of Periprosthetic Joint Infection Diagnosis: From Current Methods to Emerging Biomarkers

Abstract

Due to the increase in the life span and mobility at older ages, the number of implanted prosthetic joints is constantly increasing. However, the number of periprosthetic joint infections (PJIs), one of the most severe complications after total joint arthroplasty, also shows an increasing trend. PJI has an incidence of 1-2% in the case of primary arthroplasties and up to 4% in the case of revision operations. The development of efficient protocols for managing periprosthetic infections can lead to the establishment of preventive measures and effective diagnostic methods based on the results obtained after the laboratory tests. In this review, we will briefly present the current methods used in PJI diagnosis and the current and emerging synovial biomarkers used for the prognosis, prophylaxis, and early diagnosis of periprosthetic infections. We will discuss treatment failure that may result from patient factors, microbiological factors, or factors related to errors during diagnosis.

Keywords: arthroplasty; biomarkers; joint infection; periprosthetic; synovial culture.

Figure 1

Criteria and strategies used in PJI (periprosthetic joint infection) diagnosis. Legend: ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; WBC, white blood cells; LE, leukocyte esterase; PMN, polymorphonuclear neutrophil (modified from Alvand et al., 2020 [15] with permission).