Alisina Shahi, MD, PhD

Periprosthetic joint infection remains one of the most dreaded complications following joint arthroplasty.

Next-generation sequencing has emerged as a revolutionary tool with extensive applications in medicine ranging from cancer screening to diagnosing infections across specialties, including orthopedic surgery.

Diagnosis of periprosthetic joint infection is still a challenge due to a lack of an absolute test. When a clinician encounters a suspected periprosthetic joint infection case, he or she has to use a combination of tests, all of which can be invasive and expensive. Even with a combination of tests, it is difficult to reach a firm diagnosis in many cases.

The increasing burden and the immense financial impact of periprosthetic joint infection compel the orthopedic community to seek all potential infection control measures. Based on the teachings of Sir John Charnley and the literature from the early era of total joint arthroplasty, orthopedic surgeons are aware that an ultra-clean OR environment is critical to minimize the number of airborne particulate matters that can contaminate the wound and lead to infection of the implanted foreign material. It is known that airborne and non-airborne bacterial contaminations are the major source of infection in ORs.

Analysis of the synovial fluid plays an important role in the evaluation of joint disease and in particular the diagnosis of infection. For decades the orthopedic community has used the white cell count and neutrophil differential of the synovial fluid for diagnosis of septic arthritis and periprosthetic joint infection. The story behind the investigation of synovial fluid is an interesting one.