Stop Overcomplicating PJI Workups: The Data on Synovial NLR and ANC

Exploring the diagnostic accuracy of novel synovial biomarkers to determine if changing your screening algorithm actually drives clinical success.

Periprosthetic joint infection (PJI) remains one of the most common causes of early revision total joint arthroplasty (TJA), representing 14.8% of total hip arthroplasty (THA) and 25.5% of total knee arthroplasty (TKA) revisions performed in the United States. Revision takes a great toll on patients, surgeons, healthcare professionals, hospitals, and the healthcare system, carrying an in-hospital mortality rate higher than that of coronary or carotid procedures.

While the American Academy of Orthopaedic Surgeons and international consensus groups outline clear diagnostic guidelines, no single test or scoring method has been shown to be 100% sensitive and specific in diagnosing PJI. Furthermore, while novel biomarkers like alpha-defensin, calprotectin, and adenosine offer potential for increased detection, they are costly and remain unavailable in many standard hospital laboratories.