Abstract
Diagnosis of periprosthetic joint infection (PJI) is not straightforward. PJI’s presentation in infected total knee replacement (TKR) can be varied and the diagnosis may be challenging. Even the definition of infected arthroplasty is still subject to debate. Misdiagnosis of an infected TKR can lead to lifelong problems for patients. Although many diagnostic tools are identified, a highly accurate single test is lacking. The first point is the high index of clinical suspicion of the surgeon. Then the diagnosis must rely on a combination of some laboratory and radiological workup such as serology, culture, imaging, and basic molecular techniques. Many systematic algorithms are suggested to avoid misdiagnosis of PJI.
Traditional serological tests, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are still very important with their high negative predictive value. Cultures still remain a gold standard in diagnosis because for accurate treatment the identification of the causative agent is crucial. However, the most important pitfall regarding culture is its false-negative results. New high-tech molecular diagnosis methods are promising and identify the causative agents missed by culture, but they are not widely available and are expensive.
The surgeon should consider histology in decision making if they can ensure the experience of the pathologist and the region where the samples were obtained, and some conditions such as recent periprosthetic fractures or an inflammatory arthropathy are excluded.
Imaging is an inevitable tool in diagnosis; however, one should keep in mind that all these modalities are low in specificity. Although some recent studies suggest the FDG-PET as a promising diagnostic tool, it is not appropriate to use in daily basis.
Recently, another promising test for the diagnosis of PJI under evaluation is synovial leukocyte esterase. This chapter focuses on an updated scope of diagnosis of infected TKR.
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Aggarwal, A., Parvizi, J. (2015). 27 Diagnosis of Periprosthetic Joint Infection After Total Knee Replacement. In: Hirschmann, M., Becker, R. (eds) The Unhappy Total Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-08099-4_33
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DOI: https://doi.org/10.1007/978-3-319-08099-4_33
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