Table 1
Summary of the diagnostic criteria for PJI according to various guidelines from 2011 to 2021. Criteria include sinus tract formation and purulent material, laboratory biomarkers such as CRP and ESR, synovial fluid analysis, and other diagnostic methods such as microbiology and histology.
| Diagnostic criteria | MSIS 2011 | IDSA 2013 | ICM 2013 | ICM 2018 | EBJIS 2021 |
|---|---|---|---|---|---|
| Clinical | |||||
| Sinus tract | Yes | Yes | Yes | Yes | Yes |
| Purulent material | Yes | Yes | No | Yes | Yes |
| Blood | |||||
| CRP (mg/L) | High | No | 10 | 10 | >10 |
| ESR (mm/h) | High | No | 30 | 30 | No |
| D-Dimer (μg/L) | No | No | 30 | No | |
| Synovial fluid cytological analysis | |||||
| Synovial leukocyte count (cells/uL) | Yes | No | 3000 | 3000 | >1500 |
| Synovial PMN (%) | High | No | 90 | 70 | 65 |
| Synovial fluid biomarkers | |||||
| Alpha defensin | No | No | No | 1.0 | Yes |
| Leukocyte esterase | No | No | Positive | Positive (high) | No |
| Microbiology | |||||
| Culture | 1 | 1 | Yes | Yes | >1 |
| Sonication (CFU/ml) | No | No | No | No | >1 |
| Histology | |||||
| High-power field (400x magnification) | >5 neutrophils per HPF in 5 PHF | Yes | >5 neutrophils per HPF in 5 PHF | Yes | >5 neutrophils in single HPF |
| Other | |||||
| Nuclear imaging (WBC scintigraphy) | No | No | No | No | Yes |
CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; PMN: polymorphonuclear neutrophils; WBC: white blood cell count.
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