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Review
. 2023 May 9;8(5):253-263.
doi: 10.1530/EOR-23-0044.

Making the diagnosis in prosthetic joint infection: a European view

Martin McNally  1 , Irene Sigmund  1   2 , Andrew Hotchen  1 , Ricardo Sousa  3
Affiliations
Review

Making the diagnosis in prosthetic joint infection: a European view

Martin McNally et al. EFORT Open Rev. .

Abstract

Prosthetic joint infections (PJI) can be difficult to diagnose. Studies have shown that we are missing many infections, possibly due to poor diagnostic workup and the presence of culture-negative infection. PJI diagnosis requires a methodical approach and a standardised set of criteria. Multiple PJI definitions have been published with improved accuracy in recent years. The new European Bone and Joint Infection Society definition offers some advantages in clinical practice. It identifies more clinically important infections and accurately defines those with the highest risk of treatment failure. It reduces the number of patients with uncertain diagnoses. Classification of PJIs may offer a better understanding of treatment outcomes and risk factors for failure.

Keywords: EBJIS; biomarkers; classification; definition; diagnosis; histology; microbiology; prosthetic joint infection.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
The timeline of PJI definitions.
Figure 2
Figure 2
EBJIS criteria for the diagnosis of clinically suspected prosthetic joint infection is presented. This figure places each diagnostic test in one of three groups, depending on the sensitivity and specificity of that test. The summary key provides caveats and guidance on using the definition clinically. (Reproduced from McNally et al. (5))
Figure 3
Figure 3
The EBJIS PJI definition identified all cases diagnosed by the 2018 ICM and IDSA definitions. Numbers refer to the actual number of cases with confirmed infection by each criteria (adapted from Sigmund et al.Bone J Res 2022) (55).
Figure 4
Figure 4
Receiver–operator curve plots for the three definitions (IDSA, 2018 ICM and EBJIS) showing the better preoperative predictive ability of the EBJIS definition (adapted from Sigmund et al. 2022) (55).
Figure 5
Figure 5
The JS-BACH classification of bone and joint infection. The JS variable is used for PJI and the B variable for osteomyelitis. Both PJI and osteomyelitis use the antimicrobial options, coverage of the soft tissue and the host status variables to determine the complexity of the infection.
See this image and copyright information in PMC

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