Gram Stain
We recommend against the use of intraoperative Gram stain to rule out periprosthetic joint infection.
STRONG RECOMMENDATION Rationale
Our systematic review included three studies of Gram stain in the diagnosis of periprosthetic joint infection.3, 78, 100 Negative likelihood ratios suggest this is not a good “rule out” test (values >0.5). Comparatively, negative likelihood ratios for synovial fluid white blood cell count and differential tests (Recommendation 4) are much lower (<0.1). Thus, Gram stain is not a useful test for ruling out periprosthetic infection.
- (100) Spangehl MJ, Masterson E, Masri BA, O'Connell JX, Duncan CP. The role of intraoperative gram stain in the diagnosis of infection during revision total hip arthroplasty. J Arthroplasty 1999;14(8):952-956.
- (3) Banit DM, Kaufer H, Hartford JM. Intraoperative frozen section analysis in revision total joint arthroplasty. Clin Orthop Relat Res 2002;(401):230-238.
- (78) Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am 2006;88 Suppl 4:138-147.