ArticleBone & joint research2025
Performance of established test methods for diagnosing chronic periprosthetic joint infections caused by low-virulence pathogens.
Article in Bone & joint research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Catastrophic Acetabular Osteolysis and Component Migration Secondary to Surgical Cup Malpositioning: A Case Report.Cureus · 2026Article
- [Acute diagnostics-focus on septic arthritis].Zeitschrift fur Rheumatologie · 2026Review
- CXCL5 suppresses osteoclastogenesis and protects against lipoteichoic acid-induced bone loss by modulating PLCγ2 and c-Fos signalling in gram-positive periprosthetic joint infection.Bone & joint research · 2026Article
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Authors and funding
8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Aims: Chronic periprosthetic joint infections (PJIs) caused by low-virulence pathogens can be challenging to differentiate from aseptic failure. The aim of this study was to assess the diagnostic accuracy of the most commonly used tests for diagnosing these PJIs. Methods: A consecutive series of 420 patients undergoing revision total hip or knee arthroplasty were studied. Coagulase-negative staphylococci, Results: The calculated synovial fluid percentage of polymorphonuclear neutrophils (SF-%PMN) cut-off of > 67% demonstrated the best preoperative performance with a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 97.1% (95% CI 83.9 to 100), 97.2% (95% CI 91.9 to 100), 97.1% (95% CI 91.6 to 100), 97.2% (95% CI 91.9 to 100), and 0.972 (95% CI 0.933 to 1.000), followed by SF white blood cell count (SF-WBC) > 2,403 cells/µl with estimates of 85.4% (95% CI 71.1 to 93.4), 100% (95% CI 94.6 to 100), 100% (100), 93.3% (95% CI 88.0 to 98.5), and 0.927 (95% CI 0.872 to 0.982). While a %PMN cut-off of > 67% outperformed the established threshold of > 80% (p = 0.010), the calculated SF-WBC cut-off of > 2,403 G/l did not perform significantly better than the established threshold of > 3,000 G/l (p = 0.266). Intraoperatively, permanent paraffin-fixed sections showed the best accuracy with performance values of 89.3% (95% CI 78.1 to 95.3), 100% (95% CI 97.7 to 100), 100% (100), 97.1% (95% CI 94.8 to 99.4), and 0.946 (95% CI 0.906 to 0.987), followed by frozen sections (85.7% (95% CI 67.7 to 94.6), 99.2% (95% CI 95.1 to 100), 95.8% (95% CI 87.8 to 100), 96.9% (95% CI 94.0 to 99.9), and 0.922 (95% CI 0.853 to 0.991)). Conclusion: Synovial fluid %PMN and WBC, and permanent histological sections demonstrated the highest diagnostic performance for diagnosing PJI caused by low-virulence pathogens. Intraoperative frozen sections proved to be a valuable intraoperative tool, particularly in cases with unclear preoperative diagnosis. A lower cut-off for SF-%PMN may be considered to more accurately diagnose these infections.
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