Differential Diagnosis of Periprosthetic Joint Infection

Ilan Small, Nicolaas C. Budhiparama*, Noam Shohat

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Over one million total knee arthroplasty (TKA) surgeries are projected to be performed in the USA by 2030 (Sloan et al., J Bone Joint Surg, 100, pp 1455-1460, 2018). With the growing number of annual arthroplasties, it is vital that physicians are aware of potential causes of knee arthroplasty failures (Kurtz et al., J Arthroplasty, 27(8), 61-65, 2012; George et al., J Bone Joint Infect 4, 20, 2019). Periprosthetic joint infection (PJI) arising after TKA remains the most frequent cause of failure (Beam and Osmon, Adv Orthop 32, 843-859, 2019; Runner et al., Adv Orthop, 2019, 4629503, 2019). PJI diagnosis is based on clinical symptoms, physical exam, diagnostic testing of blood and synovial fluid, as well as cultures and histology from the joint (Parvizi, J Arthroplasty 33, 1309-1314, 2018). In an effort to distinguish PJI from aseptic causes of failure, various diagnostic criteria and algorithms for diagnosis have been introduced in the past decade, which has led to several medical organizations to provide official recommendations (Parvizi et al., J Arthroplasty 33, 1309-1314, 2018; Clin Orthop Relat Res, 469(11), 2992, 2011; Bone Joint J 95, 1450-1452, 2013). While these recommendations have contributed to a better understanding and have improved research in the field, diagnosing PJI remains a significant challenge, and this is especially true in a subset of pathologies. In this chapter we will discuss the differential diagnosis of PJI with a special focus on those cases where a diagnosis is especially hard to make or may be inaccurate if conventional diagnostic criteria are used.

Original languageEnglish
Title of host publicationInfection in Knee Replacement
PublisherSpringer International Publishing
Number of pages6
ISBN (Electronic)9783030815530
ISBN (Print)9783030815523
StatePublished - 1 Jan 2021


  • Aseptic failure
  • Culture negative
  • Differential diagnosis
  • Inflammatory arthritis


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