JBJS - 2026-08-05 - Journal Article; Review
The Persistent Challenges of Diagnosing Orthopaedic Implant-Related Infections.
Lum ZC, Cohen-Rosenblum A, Yao JJ, Chen AF, Landy DC, Parvizi J
Topics
Key Takeaway
No single diagnostic test achieves sufficient sensitivity and specificity for orthopaedic implant-related infection, necessitating multimodal diagnostic algorithms that vary by anatomic site and organism.
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Summary
This narrative review synthesizes current evidence on the diagnostic challenges of orthopaedic implant-related infections, addressing limitations of molecular diagnostics, biomarker assays, and consensus definitions such as the ICM (International Consensus Meeting) criteria. The authors highlight that biological diversity of infecting organisms, variable host immune responses, and site-specific differences preclude a universal gold standard. No original data are presented; conclusions are drawn from synthesis of high-impact literature and consensus frameworks.
Key Limitation
As a narrative review without a registered protocol or systematic search strategy, the evidence synthesis cannot be reproduced and may overrepresent studies supporting the authors' conclusions.
Original Abstract
Infection remains one of the most catastrophic complications following orthopaedic surgery. Despite substantial advances in molecular diagnostics, biomarker assays, and consensus definitions, accurately diagnosing orthopaedic infection continues to challenge even the most experienced clinicians. There are differences in the diagnosis and treatment of infections that are related to different anatomic regions. The difficulty arises from the inherent biological diversity of infecting organisms and surgical locations, variable host responses, and the absence of a true diagnostic "gold standard." This article summarizes the current diagnostic challenges and emerging solutions, drawing on recent high-impact evidence and consensus frameworks.