Periprosthetic joint infections occur in a replacement joint and are often found deep inside the joint prosthesis. It has become a major concern as antibiotic-resistance organisms have increased the prevalence of post-surgical periprosthetic infections. Deep periprosthetic joint infection is currently the most common indication for revision of total knee arthroplasty and the third most frequent indication for revision of total hip arthroplasty.
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The group’s recommendations include sterile sampling of the periprosthetic tissue or fluid for the presence of virulent organisms, such as S. aureus, and testing the blood serum surrounding the joint for elevated levels of known biomarkers for systemic inflammation and infection, C-reactive protein and erythrocyte sedimentation rate. They recommend certain considerations as the level of serum markers is affected by age, sex and medical comorbidities.
Aspiration and supplementary testing of the synovial fluid is also suggested to look for elevated white blood cell counts, specifically the percentage of neutrophils, which is plentiful in infected bone marrow. The appearance of joint during surgery, presence or absence of a sinus tract and the result of histological analysis of tissue obtained during surgery (frozen section) are also recommended to consider in diagnosing PJI.
These criteria have been evaluated and endorsed by the Knee Society, the Hip Society, the Infectious Disease Society of North America, the American Association of Orthopedic Surgeons and the CDC.
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