PJI Impactful Statements

The following impactful statements are based on the Diagnosis of Periprosthetic Joint Infections of the Hip and Knee Clinical Practice Guideline.

  1. Antibiotics should not be administered to patients suspected of having a periprosthetic joint infection (PJI) until the patient has been adequately evaluated for PJI and cultures have been obtained from the joint.
  2. Patients suspected of having a periprosthetic joint infection or who are scheduled for revision surgery should have a serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) obtained.
  3. In patients being evaluated for periprosthetic joint infection, if the ESR and/or CRP are elevated or if the clinical suspicion of PJI is high, the joint should be aspirated and the fluid should sent for a synovial fluid white blood cell count, differential and culture.
  4. Surgeons should obtain multiple cultures at the time of surgery in patients being assessed for periprosthetic joint infections.
  5. Intraoperative Gram stains are not reliable to rule out periprosthetic joint infections and should not be routinely performed.

 

The following recommendation is the basis of the statements above.

  1. We recommend against initiating antibiotic treatment in patients with suspected periprosthetic joint infection until after cultures from the joint have been obtained.
  2. We recommend erythrocyte sedimentation rate and C-reactive protein testing for patients assessed for periprosthetic joint infection.
  3. We recommend a selective approach to aspiration of the hip based on the patient’s probability of periprosthetic joint infection and the results of the erythrocyte sedimentation rate (ESR) AND C-reactive protein (CRP). We recommend that the aspirated fluid be sent for microbiologic culture, synovial fluid white blood cell count and differential.
  4. We recommend that multiple cultures be obtained at the time of reoperation in patients being assessed for periprosthetic joint infection.
  5. We recommend against the use of intraoperative Gram stain to rule out periprosthetic joint infection.