Table 3
The European Bone and Joint Infection Society (EBJIS) definition for diagnosing periprosthetic joint infection (knee and hips).
| Infection | Unlikely | Likely | Confirmed |
|---|---|---|---|
| Clinical/blood | |||
| Clinical features | Implant dysfunction due to alternative cause (fracture, implant breakage, malposition, tumor). |
|
Sinus tract communicating to the joint or when prosthesis can be visualized. |
| CRP | More than 10 mg/L | ||
| Synovial fluid | |||
| Leukocyte count (cells/μL) | ≤1500 | >1500 | >3000 |
| PMN% | ≤65% | >65% | >80% |
| Alpha-defensin | Positive | ||
| Microbiology | |||
| Culture – aspirated fluid | Positive | ||
| Culture – intraoperative | Negative | One positive | ≥Two positives (same organism) |
| Sonication (CFU/mL) | No growth | >1 CFU/mL (any organism) | >50 CFU/mL (any organism) |
| Histology – High-power field (400×) | Negative | ≥5 neutrophils/HPF | ≥5 in ≥HPFs |
| Visible organisms | |||
| Nuclear imaging | Negative 3-phase isotope bone scan | Positive white blood cell scintigraphy | |
C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); CFU: colony forming unit; polymorphonuclear neutrophils (PMN).
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