Joint Prosthesis Infection

Question 1

Periprosthetic joint infection criteria

Answer 1

EBJIS “Confirmatory” Single Criteria
Two positive cultures (includes synovial fluid, tissue, and sonicate-fluid cultures) for the same microorganism
Sinus tract with communication to joint or prosthesis
Synovial fluid leukocyte count, >3000/ml†
Synovial fluid neutrophils, >80%†
Synovial fluid alpha-defensin positive:
Sonicate-fluid culture, >50 FU/ml for any organism
(>200 CFU/ml if centrifuged)
Histopathological assessment (high-power field, 400x magnification) showing ≥5 neutrophils in =5 high-power fields (or visible microorganisms)

Signore, A., Sconfienza, L.M., Borens, O. et al. Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 46, 971–988 (2019).

Question 2

Periprosthetic joint infection prevention

Answer 2

Pre operative screening for S aureus colonization with decolonization of carriers, or universal decolonization
Cleansing with clorhexidine
Adding vancomycin to perioperative cefazolin

Patel R. Periprosthetic Joint Infection. N Engl J Med. 2023 Jan 19;388(3):251-262.