Optimized use and performance of culture for periprosthetic joint infection diagnosis: a comprehensive literature review

SUMMARY Periprosthetic joint infection (PJI) is a significant complication of arthroplasty. Implicit in the diagnosis of PJI is the presence of organisms in what should be a sterile milieu. Given limits to culture-based PJI diagnosis, optimal utilization of culture in the diagnostic approach to PJI needs clarification. Culture is important in confirming a PJI diagnosis and characterizing the infecting microorganism(s) to inform management. As part of the development of a unified definition of PJI (by a group representing multiple scientific societies), a systematic review was performed to inform the role of culture in the definition of PJI. In addition, a comprehensive review on synovial fluid and periprosthetic tissue collection for culture, and associated culture methodology and results interpretation, was performed to inform best practices. Gaps in the literature were identified to develop research priorities.