New Diagnostic Tools for Diagnosis Periprosthetic Joint Infections

Thorsten Gehrke, MD
Periprosthetic joint infection (PJI) is a major complication of total joint arthroplasty. When facing such complication, a correct and prompt diagnosis is of paramount importance because the management of this complication differs from that of other causes of arthroplasty failure. However, the diagnosis of PJI is quite challenging and often delayed, as infections can be difficult to differentiate from other forms of inflammation. Moreover, a unique diagnostic test of synovial fluid or blood test with 100% accuracy, sensitivity and specificity is not available. Nevertheless, in the last 10 years, there have been important developments in the PJI diagnosticsuch as Leucocyte Esterase Test, Multiplex PCR, D-Dimere and Alpha-defensin. In general, the Synovial fluid biomarkers are more accurate for the diagnosis of PJI compared to serum biomarkers. For instance, the LE-test is cost-effectiveand has a high sensitivity and specificity. In recent years, the Alpha-defensin immunoassay has gained increasing popularity and demonstrated promising results. Until now, this method seems to be the most accurate test for the diagnosis of PJI when compared to other previous traditional serum and synovial fluid analyses with a sensitivity and specificity reported being above 96%. We here present an overview of the current available PJI diagnostic methods.