The following impactful statements are based on the Diagnosis of Periprosthetic Joint Infections of the Hip and Knee Clinical Practice Guideline.
- 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.
- 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.
- 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.
- Surgeons should obtain multiple cultures at the time of surgery in patients being assessed for periprosthetic joint infections.
- 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.
- We recommend against initiating antibiotic treatment in patients with suspected periprosthetic joint infection until after cultures from the joint have been obtained.
- We recommend erythrocyte sedimentation rate and C-reactive protein testing for patients assessed for periprosthetic joint infection.
- 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.
- We recommend that multiple cultures be obtained at the time of reoperation in patients being assessed for periprosthetic joint infection.
- We recommend against the use of intraoperative Gram stain to rule out periprosthetic joint infection.