Accuracy of diagnostic tests for prosthetic joint infection: a systematic review.

Ahmad, SS; Shaker, A; Saffarini, Mo; Chen, Antonia F; Hirschmann, Michael T; Kohl, S (2016). Accuracy of diagnostic tests for prosthetic joint infection: a systematic review. Knee surgery, sports traumatology, arthroscopy, 24(10), pp. 3064-3074. Springer 10.1007/s00167-016-4230-y

[img] Text
art_10.1007_s00167-016-4230-y.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

PURPOSE There are few evidence-based recommendations on the most effective methods for diagnosing prosthetic joint infections (PJIs), and the potency of tests in relation to each other also remains vague. This systematic review aimed to (1) identify systematic reviews reporting accuracies of available approaches for diagnosing PJI, (2) critically appraise their quality and bias, and (3) compare the available approaches in terms of accuracy for diagnosing PJI. METHODS PubMed and EMBASE databases were searched for meta-analyses reporting accuracies of different diagnostic modalities for PJIs. Thirteen systematic reviews met the inclusion and exclusion criteria, and their data were extracted and tabulated by two reviewers in duplicate and independent manners. RESULTS The 13 articles reported diagnostic accuracy from 278 clinical studies comprising 27,754 patients and evaluating 13 diagnostic tests grouped into 7 broad categories. Implant sonication had the highest positive likelihood ratio (17.2), followed by bacteriology (15.3) and synovial fluid differentiated cytology (13.3). The highest negative likelihood ratio was for interleukin (IL)-6 serum marker (0.03) followed by synovial fluid cytology and differentiation (0.12 and 0.13, respectively). CONCLUSION The diagnostic tests that are most likely to rule out PJI include serum IL-6, serum C-reactive protein, and synovial fluid cytology. On the other hand, the diagnostic test that is most likely to confirm PJI is implant sonication. Nuclear imaging showed low overall accuracy as diagnostic tests for PJI. The findings of this study could enable clinicians to confirm or rule out PJIs using the most accurate, rapid, least invasive, and cost-effective tools available, thereby enabling fast treatment before formation of resistant biofilms and degradation of patient conditions. LEVEL OF EVIDENCE Systematic review, Level IV.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Ahmad, Sufian; Shaker, Ahmed Mohamed Abd El Aziz and Kohl, Sandro


600 Technology > 610 Medicine & health








Lilianna Bolliger

Date Deposited:

26 Apr 2017 16:31

Last Modified:

20 Jul 2017 12:27

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Diagnosis; Diagnostic accuracy; Joint infection; PJI; Prosthetic joint infection




Actions (login required)

Edit item Edit item
Provide Feedback