2018 Evidence-based stepwise algorithm for diagnosis of PJI
| Score | Decision | |
|---|---|---|
| Major criteria (at least one of the following) | ||
| Two positive cultures of the same organism | Infected | |
| Sinus tract with evidence of communication to the joint or visualization of the prosthesis | ||
| Minor criteria (preoperative) | ||
| Elevated CRP or D-dimer (serum) | 2 | |
| Elevated ESR (serum) | 1 | ≥6 Infected |
| Elevated synovial WBC count or LE (synovial) | 3 | 2~5 Possibly infected |
| Positive alpha-defensin (synovial) | 3 | |
| Elevated synovial PMN (%) (synovial) | 2 | 0~1 Not infected |
| Elevated synovial CRP (synovial) | 1 | |
| Intraoperative diagnosis | ||
| Preoperative score | - | ≥6 Infected |
| Positive histology | 3 | 4~5 Inconclusive |
| Positive purulence | 3 | |
| Single positive culture | 2 | ≤3 Not infected |
Data from the article of Parvizi et al. (J Arthroplasty. 2018. 33: 1309-1314.e2)
PJI: periprosthetic joint infection, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, WBC: white blood cell, LE: leukocyte esterase, PMN: polymorphonuclear
