Scoring for prosthetic joint infection

Major criteria (at least one of the following)			Decision
Two positive cultures of the same organism			Infected
Sinus tract with evidence of communication to the joint or visualization of the prosthesis
Preoperative diagnosis
Minor criteria		Score	Decision
Serum	Elevated CRP or D-dimer	2	≥6 infected 2-5 possibly infected* 0-1 not infected
	Elevated ESR	1
Synovial	Elevated synovial WBC count or LE	3
	Positive alpha-defensin	3
	Elevated synovial PMN (%)	2
	Elevated synovial CRP	1
Intraoperative diagnosis
Inconclusive preoperative score or dry tap*		Score	Decision
	Preoperative score	–	≥6 infected 4-5 inconclusive^¶ ≤3 not infected
	Positive histology	3
	Positive purulence	3
	Single positive culture	2

New scoring based definition for periprosthetic joint infection (PJI). Proceed with caution in: adverse local tissue reaction, crystal deposition disease, slow growing organisms.

CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; LE: leukocyte esterase; PMN: polymorphonuclear; WBC: white blood cell.
* For patients with inconclusive minor criteria, operative criteria can also be used to fulfill definition for PJI.
¶ Consider further molecular diagnostics such as next-generation sequencing.

Reproduced from: Parvizi J, Tan TL, Goswami K, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty 2018; 33:1309. Table used with the permission of Elsevier Inc. All rights reserved.

Graphic 122283 Version 1.0

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Scoring for prosthetic joint infection