The Journal of Bone and Joint Surgery (American). 2006;88:869-882.
doi:10.2106/JBJS.E.01149
© 2006 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow [FREE Spanish Translation]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bauer, T. W.
Right arrow Articles by Krebs, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bauer, T. W.
Right arrow Articles by Krebs, V.
Related Collections
Right arrow Shoulder
Right arrow Elbow
Right arrow Adult Hip
Right arrow Adult Knee
Right arrow Foot/Ankle
Right arrow Hand/Wrist
Right arrow Current Concepts Review
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Current Concepts Review

Diagnosis of Periprosthetic Infection

Thomas W. Bauer, MD, PhD1, Javad Parvizi, MD2, Naomi Kobayashi, MD, PhD1 and Viktor Krebs, MD3

1 Departments of Pathology and Orthopaedic Surgery, The Cleveland Clinic Foundation, L25, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for T.W. Bauer: osteoclast{at}aol.com
2 The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
3 Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, A41, 9500 Euclid Avenue, Cleveland, OH 44195

Investigation performed at the Departments of Pathology and Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Stryker. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Stryker). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Periprosthetic infections are rare, but there is evidence to suggest that their frequency may be underestimated.

No single laboratory test has perfect sensitivity and specificity for diagnosing infection. Most tests have better specificity when they are performed for patients in whom infection is suspected clinically rather than when they are used as screening tests.

Screening test results that may suggest the possibility of infection include elevation of the erythrocyte sedimentation rate and/or serum C-reactive protein level more than three months after an arthroplasty. Most serologic tests are difficult to interpret when the patient has an underlying inflammatory arthropathy.

Cultures of aspirated joint fluid can be especially helpful for patients who have symptoms suggestive of infection, but their results are best interpreted two weeks after administration of antibiotics has been discontinued. Joint fluid cell counts may also be helpful, but Gram stains of joint fluid have poor sensitivity and specificity.

Criteria for diagnosing infection on the basis of frozen sections of implant membranes have not yet been standardized, but in many laboratories more than five neutrophils per high-power field in five or more fields (excluding surface fibrin) has been found to be suggestive of infection.

Most polymerase chain reactions that detect the universal 16S rRNA bacterial gene have problems with false-positive results, but combining a universal polymerase chain reaction with subsequent bacterial sequencing can help improve specificity. Polymerase chain reactions can detect necrotic bacteria, so the clinical importance of positive results of this analysis in the absence of other features of infection remains to be determined.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
E. Ghanem, J. Parvizi, R. S. J. Burnett, P. F. Sharkey, N. Keshavarzi, A. Aggarwal, and R. L. Barrack
Cell Count and Differential of Aspirated Fluid in the Diagnosis of Infection at the Site of Total Knee Arthroplasty
J. Bone Joint Surg. Am., August 1, 2008; 90(8): 1637 - 1643.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
P. Birmingham, J. M. Helm, P. A. Manner, and R. S. Tuan
Simulated Joint Infection Assessment by Rapid Detection of Live Bacteria with Real-Time Reverse Transcription Polymerase Chain Reaction
J. Bone Joint Surg. Am., March 1, 2008; 90(3): 602 - 608.
[Abstract] [Full Text] [PDF]

Home page
 Cancer Res.Home page
C. Rago, D. L. Huso, F. Diehl, B. Karim, G. Liu, N. Papadopoulos, Y. Samuels, V. E. Velculescu, B. Vogelstein, K. W. Kinzler, et al.
Serial Assessment of Human Tumor Burdens in Mice by the Analysis of Circulating DNA
Cancer Res., October 1, 2007; 67(19): 9364 - 9370.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
G. Bori, A. Soriano, S. Garcia, C. Mallofre, J. Riba, and J. Mensa
Usefulness of Histological Analysis for Predicting the Presence of Microorganisms at the Time of Reimplantation After Hip Resection Arthroplasty for the Treatment of Infection
J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1232 - 1237.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
D. J. F. Moojen, S. N.M. Spijkers, C. S. Schot, M. W. Nijhof, H. C. Vogely, A. Fleer, A. J. Verbout, R. M. Castelein, W. J.A. Dhert, and L. M. Schouls
Identification of Orthopaedic Infections Using Broad-Range Polymerase Chain Reaction and Reverse Line Blot Hybridization
J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1298 - 1305.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
J. Parvizi, E. Ghanem, S. Menashe, R. L. Barrack, and T. W. Bauer
Periprosthetic Infection: What Are the Diagnostic Challenges?
J. Bone Joint Surg. Am., December 1, 2006; 88(suppl_4): 138 - 147.
[Full Text] [PDF]