Diagnostic Process of Periprosthetic Joint Infection in Painful Arthroplasty Patients Referred to a Tertiary Care Center: Orthopedics and Pathology Perspective

This study was aimed at determining the method of diagnosis of periprosthetic infection in the patients with painful joint arthroplasty referred to a tertiary center. Between January 2021 and January 2024, 85 patients referred for painful hip and knee arthroplasty were retrospectively evaluated. The median age of the patients was 67 years and 58.8% underwent total knee arthroplasty. Pathologically, 52.9% of the cases were reported as non-infectious, 29.4% as infectious and 17.7% as indeterminate. The presence of infectious pathology was strongly associated with the diagnosis of PEE (OR: 4.92, p=0.001), while the presence of non-infectious pathology was negatively associated (OR: 0.31, p=0.026). Neutrophil infiltration and bacterial colonization were independent markers for the diagnosis of infection. Fibrohistiocytic reaction was the dominant finding in cases of aseptic loosening. After controlling for demographic factors, the diagnostic contribution of pathologic evaluation was statistically significant. Our findings underscore the need for pathological assessment and highlight the importance of a team approach with different specializations in managing arthroplasty who complain of pain.