Aims. The diagnosis of periprosthetic joint infection can be difficult
due to the high rate of culture-negative infections. The aim of
this study was to assess the use of next-generation sequencing for
detecting organisms in synovial fluid. Materials and Methods. In this prospective, single-blinded study, 86 anonymized samples
of synovial fluid were obtained from patients undergoing aspiration
of the hip or knee as part of the investigation of a periprosthetic
infection. A panel of synovial fluid tests, including levels of
C-reactive protein, human neutrophil elastase, total neutrophil
count, alpha-defensin, and culture were performed prior to next-generation
sequencing. Results. Of these 86 samples, 30 were alpha-defensin-positive and culture-positive
(Group I), 24 were alpha-defensin-positive and culture-negative
(Group II) and 32 were alpha-defensin-negative and culture-negative
(Group III). Next-generation sequencing was concordant with 25 results
for Group I. In four of these, it detected antibiotic resistant bacteria
whereas culture did not. In another four samples with relatively
low levels of inflammatory
Periprosthetic joint infection (PJI) is one of
the most feared and challenging complications following total knee arthroplasty.
We provide a detailed description of our current understanding regarding
the management of PJI of the knee, including diagnostic aids,
pre-operative planning, surgical treatment, and outcome. Cite this article:
