This 2010 AAOS clinical practice guideline systematically reviews the diagnostic workup for periprosthetic joint infection (PJI) of the hip and knee, evaluating each available modality — serology, aspiration, imaging, intraoperative tests — to produce a practical, evidence-graded algorithm for clinicians.
When a patient with a total hip or knee presents with pain and possible failure, start with ESR + CRP together — if both are normal, infection is essentially ruled out; if abnormal, proceed to aspiration with WBC count, differential, and culture.
Before you aspirate or take intraoperative cultures, hold antibiotics for at least 2 weeks; don't rely on Gram stain intraoperatively, and use frozen section when infection status is still unclear at the time of reoperation.
This 2010 AAOS clinical practice guideline systematically reviews the diagnostic workup for periprosthetic joint infection (PJI) of the hip and knee, evaluating each available modality — serology, aspiration, imaging, intraoperative tests — to produce a practical, evidence-graded algorithm for clinicians.
When a patient with a total hip or knee presents with pain and possible failure, start with ESR + CRP together — if both are normal, infection is essentially ruled out; if abnormal, proceed to aspiration with WBC count, differential, and culture.
Before you aspirate or take intraoperative cultures, hold antibiotics for at least 2 weeks; don't rely on Gram stain intraoperatively, and use frozen section when infection status is still unclear at the time of reoperation.