Culture-negative Periprosthetic Joint Infections

Overview

Journal EFORT Open Rev

Specialty Orthopedics

Date 2019 Nov 23

PMID 31754464

Citations 43

Authors

Jeya Palan

Ciaran Nolan

Kostas Sarantos

Richard Westerman

Richard King

Pedro Foguet

Affiliations

Soon will be listed here.

Abstract

Culture-negative periprosthetic joint infections (CN-PJI) pose a significant challenge in terms of diagnosis and management. The reported incidence of CN-PJI is reported to be between 7% and 15%.Fungi and mycobacterium are thought to be responsible for over 85% of such cases with more fastidious bacteria accounting for the rest.With the advent of polymerase chain reaction, mass spectrometry and next generation sequencing, identifying the causative organism(s) may become easier but such techniques are not readily available and are very costly.There are a number of more straightforward and relatively low-cost methods to help surgeons maximize the chances of diagnosing a PJI and identify the organisms responsible.This review article summarizes the main diagnostic tests currently available as well as providing a simple diagnostic clinical algorithm for CN-PJI. Cite this article: 2019;4:585-594. DOI: 10.1302/2058-5241.4.180067.

Citing Articles

Preoperative Diagnosis of Periprosthetic Infection in Patients Undergoing Hip or Knee Revision Arthroplasties: Development and Validation of Machine Learning Algorithm.

Di Matteo V, Morandini P, Savevski V, Grappiolo G, Loppini M Diagnostics (Basel). 2025; 15(5).

PMID: 40075787 PMC: 11898876. DOI: 10.3390/diagnostics15050539.

Diagnosing Mycobacterium Kansasii in Shoulder Periprosthetic Joint Infection: A Rare Case Report.

Peresada D, Mungalpara N, Deshpande A, Patetta M, Goldberg B J Orthop Case Rep. 2025; 15(1):83-89.

PMID: 39801889 PMC: 11723734. DOI: 10.13107/jocr.2025.v15.i01.5134.

Is the Presence of Sinus Tract in Periprosthetic Joint Infection Still One of the Main Deciding Factors for Septic Revision?.

Sandu E, Cursaru A, Serban B, Iordache S, Costache M, Cirstoiu C Cureus. 2024; 16(12):e75379.

PMID: 39654596 PMC: 11627193. DOI: 10.7759/cureus.75379.

DAIR for periprosthetic joint infections-One week to save the joint?.

Gupta V, Shahban S, Petrie M, Kimani P, Kozdryk J, Riemer B Arthroplasty. 2024; 6(1):61.

PMID: 39633436 PMC: 11619623. DOI: 10.1186/s42836-024-00282-y.

A novel synthetic synovial fluid model for investigating biofilm formation and antibiotic susceptibility in prosthetic joint infections.

De Bleeckere A, van Charante F, Debord T, Vandendriessche S, De Cock M, Verstraete M Microbiol Spectr. 2024; 13(1):e0198024.

PMID: 39612218 PMC: 11705890. DOI: 10.1128/spectrum.01980-24.

References

Lee Y, Lee Y, Han S, Nam C, Parvizi J, Koo K . Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection. J Orthop Surg Res. 2018; 13(1):36. PMC: 5811971. DOI: 10.1186/s13018-018-0730-4. View

Liu H, Zhang Y, Li L, Zou H . The application of sonication in diagnosis of periprosthetic joint infection. Eur J Clin Microbiol Infect Dis. 2016; 36(1):1-9. DOI: 10.1007/s10096-016-2778-6. View

Parikh M, Antony S . A comprehensive review of the diagnosis and management of prosthetic joint infections in the absence of positive cultures. J Infect Public Health. 2016; 9(5):545-56. DOI: 10.1016/j.jiph.2015.12.001. View

Zappe B, Graf S, Ochsner P, Zimmerli W, Sendi P . Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge. Arch Orthop Trauma Surg. 2007; 128(10):1039-46. DOI: 10.1007/s00402-007-0454-0. View

Shahi A, Kheir M, Tarabichi M, S Hosseinzadeh H, Tan T, Parvizi J . Serum D-Dimer Test Is Promising for the Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation. J Bone Joint Surg Am. 2017; 99(17):1419-1427. DOI: 10.2106/JBJS.16.01395. View

Aggarwal V, Bakhshi H, Unter Ecker N, Parvizi J, Gehrke T, Kendoff D . Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg. 2014; 27(5):399-406. DOI: 10.1055/s-0033-1364102. View

Evangelopoulos D, Stathopoulos I, Morassi G, Koufos S, Albarni A, Karampinas P . Sonication: a valuable technique for diagnosis and treatment of periprosthetic joint infections. ScientificWorldJournal. 2013; 2013:375140. PMC: 3810485. DOI: 10.1155/2013/375140. View

Peel T, Buising K, Choong P . Diagnosis and management of prosthetic joint infection. Curr Opin Infect Dis. 2012; 25(6):670-6. DOI: 10.1097/QCO.0b013e32835915db. View

Ivy M, Thoendel M, Jeraldo P, Greenwood-Quaintance K, Hanssen A, Abdel M . Direct Detection and Identification of Prosthetic Joint Infection Pathogens in Synovial Fluid by Metagenomic Shotgun Sequencing. J Clin Microbiol. 2018; 56(9). PMC: 6113468. DOI: 10.1128/JCM.00402-18. View

10.

Sigmund I, Holinka J, Gamper J, Staats K, Bohler C, Kubista B . Qualitative α-defensin test (Synovasure) for the diagnosis of periprosthetic infection in revision total joint arthroplasty. Bone Joint J. 2017; 99-B(1):66-72. DOI: 10.1302/0301-620X.99B1.BJJ-2016-0295.R1. View

11.

Rak M, KavcIc M, Trebse R, Cor A . Detection of bacteria with molecular methods in prosthetic joint infection: sonication fluid better than periprosthetic tissue. Acta Orthop. 2016; 87(4):339-45. PMC: 4967274. DOI: 10.3109/17453674.2016.1165558. View

12.

Aggarwal V, Tischler E, Ghanem E, Parvizi J . Leukocyte esterase from synovial fluid aspirate: a technical note. J Arthroplasty. 2012; 28(1):193-5. DOI: 10.1016/j.arth.2012.06.023. View

13.

Tarabichi M, Shohat N, Goswami K, Parvizi J . Can next generation sequencing play a role in detecting pathogens in synovial fluid?. Bone Joint J. 2018; 100-B(2):127-133. DOI: 10.1302/0301-620X.100B2.BJJ-2017-0531.R2. View

14.

Parvizi J, Tan T, Goswami K, Higuera C, Della Valle C, Chen A . The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018; 33(5):1309-1314.e2. DOI: 10.1016/j.arth.2018.02.078. View

15.

Million M, Bellevegue L, Labussiere A, Dekel M, Ferry T, Deroche P . Culture-negative prosthetic joint arthritis related to Coxiella burnetii. Am J Med. 2014; 127(8):786.e7-786.e10. DOI: 10.1016/j.amjmed.2014.03.013. View

16.

Trampuz A, Piper K, Jacobson M, Hanssen A, Unni K, Osmon D . Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007; 357(7):654-63. DOI: 10.1056/NEJMoa061588. View

17.

Li H, Ni M, Li X, Zhang Q, Li X, Chen J . Two-stage revisions for culture-negative infected total knee arthroplasties: A five-year outcome in comparison with one-stage and two-stage revisions for culture-positive cases. J Orthop Sci. 2016; 22(2):306-312. DOI: 10.1016/j.jos.2016.11.008. View

18.

Parvizi J, Gehrke T . Definition of periprosthetic joint infection. J Arthroplasty. 2014; 29(7):1331. DOI: 10.1016/j.arth.2014.03.009. View

19.

Scorzolini L, Lichtner M, Iannetta M, Mengoni F, Russo G, Panni A . Sonication technique improves microbiological diagnosis in patients treated with antibiotics before surgery for prosthetic joint infections. New Microbiol. 2014; 37(3):321-8. View

20.

Greenwood-Quaintance K, Uhl J, Hanssen A, Sampath R, Mandrekar J, Patel R . Diagnosis of prosthetic joint infection by use of PCR-electrospray ionization mass spectrometry. J Clin Microbiol. 2014; 52(2):642-9. PMC: 3911314. DOI: 10.1128/JCM.03217-13. View