Articles | Volume 6, issue 9
https://doi.org/10.5194/jbji-6-423-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-6-423-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Methylene blue for the diagnosis of a sinus tract in periprosthetic knee joint infection
Simon Martin Heinrich
CORRESPONDING AUTHOR
Centre for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
Department of Orthopaedic and Trauma Surgery, University Hospital
Basel, Basel, Switzerland
Parham Sendi
Centre for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
Department of Orthopaedic and Trauma Surgery, University Hospital
Basel, Basel, Switzerland
Department of Infectious Diseases and Hospital Epidemiology,
University Hospital Basel, Basel, Switzerland
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Martin Clauss
Centre for Musculoskeletal Infections, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
Department of Orthopaedic and Trauma Surgery, University Hospital
Basel, Basel, Switzerland
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Marta Sabater-Martos, Martin Clauss, Ana Ribau, Ricardo Sousa, and on behalf of the Leukocyte Count Synovial Fluid working group for the Unified PJI definition task force
J. Bone Joint Infect., 10, 165–184, https://doi.org/10.5194/jbji-10-165-2025, https://doi.org/10.5194/jbji-10-165-2025, 2025
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This meta-analysis evaluates synovial fluid white blood cell count and polymorphonuclear neutrophil proportion in order to diagnose chronic peri-prosthetic joint infection. Based on 74 studies, it identifies optimal thresholds, with rule-in and rule-out thresholds enhancing diagnostic precision. Confounding factors such as fractures and inflammatory arthritis are addressed. The findings support standardized diagnostic frameworks in improving accuracy and clinical consistency.
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem-Jan Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
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This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
Irene K. Sigmund, Tristan Ferry, Ricardo Sousa, Alex Soriano, Willem-Jan Metsemakers, Martin Clauss, Rihard Trebse, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 10, 101–138, https://doi.org/10.5194/jbji-10-101-2025, https://doi.org/10.5194/jbji-10-101-2025, 2025
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In this paper, we discuss the most relevant factors influencing the outcome and define indications, contraindications, and risk factors of a DAIR procedure based on the currently available literature. Furthermore, we discuss the surgical technique in combination with systemic antimicrobial therapy in patients undergoing a DAIR procedure.
Tariq Azamgarhi, Simon Warren, Antonia Scobie, Natasha Karunaharan, Cristina Perez-Sanchez, Rebecca Houghton, Salma Hassan, Julie Lourtet-Hascoët, Hannah Kershaw, Parham Sendi, and Kordo Saeed
J. Bone Joint Infect., 10, 93–100, https://doi.org/10.5194/jbji-10-93-2025, https://doi.org/10.5194/jbji-10-93-2025, 2025
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This study evaluates dalbavancin, an antibiotic with a long duration of action, in treating complex bone and joint infections. It does not require daily dosing, allowing patients to leave the hospital earlier and reducing costs. Dalbavancin is shown to be effective and safe, especially for patients unsuitable for oral antibiotics or outpatient therapy, achieving similar results to traditional treatments while cutting healthcare costs.
Alexandra Wallimann, Yvonne Achermann, Ciara Ferris, Mario Morgenstern, Martin Clauss, Vincent Stadelmann, Hannes Andreas Rüdiger, Liam O'Mahony, and Thomas Fintan Moriarty
J. Bone Joint Infect., 9, 191–196, https://doi.org/10.5194/jbji-9-191-2024, https://doi.org/10.5194/jbji-9-191-2024, 2024
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Skin commensal bacteria such as staphylococci are often the source of orthopaedic-device-related infections. Rifampicin is a widely used antibiotic in the treatment of these infections. The results of this study show that oral rifampicin therapy leads to a consistent and persistent induction of resistance in commensal staphylococci on the skin and in the nose for a prolonged time.
Noémie Reinert, Katinka Wetzel, Fabian Franzeck, Mario Morgenstern, Markus Aschwanden, Thomas Wolff, Martin Clauss, and Parham Sendi
J. Bone Joint Infect., 9, 183–190, https://doi.org/10.5194/jbji-9-183-2024, https://doi.org/10.5194/jbji-9-183-2024, 2024
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We assessed concordance of in-house guidelines for diagnostic principles and antibiotic treatment duration (ABT) 2 years after their implementation. The goal was to standardize diagnostic and treatment principles: are we doing what we recommend? The adherence to recommendations in terms of biopsy sampling was good, moderate for histopathology and poor for anatomic labeling. In terms of ABT duration, the adherence was good, but further shortening for surgically cured cases is necessary.
Stéphanie Pascual, Brooklyn Noble, Nusreen Ahmad-Saeed, Catherine Aldridge, Simone Ambretti, Sharon Amit, Rachel Annett, Shaan Ashk O'Shea, Anna Maria Barbui, Gavin Barlow, Lucinda Barrett, Mario Berth, Alessandro Bondi, Nicola Boran, Sara E. Boyd, Catarina Chaves, Martin Clauss, Peter Davies, Ileana T. Dianzo-Delgado, Jaime Esteban, Stefan Fuchs, Lennart Friis-Hansen, Daniel Goldenberger, Andrej Kraševac Glaser, Juha O. Groonroos, Ines Hoffmann, Tomer Hoffmann, Harriet Hughes, Marina Ivanova, Peter Jezek, Gwennan Jones, Zeynep Ceren Karahan, Cornelia Lass-Flörl, Frédéric Laurent, Laura Leach, Matilde Lee Horsbøll Pedersen, Caroline Loiez, Maureen Lynch, Robert J. Maloney, Martin Marsh, Olivia Milburn, Shanine Mitchell, Luke S. P. Moore, Lynn Moffat, Marianna Murdjeva, Michael E. Murphy, Deepa Nayar, Giacomo Nigrisoli, Fionnuala O'Sullivan, Büşra Öz, Teresa Peach, Christina Petridou, Mojgan Prinz, Mitja Rak, Niamh Reidy, Gian Maria Rossolini, Anne-Laure Roux, Patricia Ruiz-Garbajosa, Kordo Saeed, Llanos Salar-Vidal, Carlos Salas Venero, Mathyruban Selvaratnam, Eric Senneville, Peter Starzengruber, Ben Talbot, Vanessa Taylor, Rihard Trebše, Deborah Wearmouth, Birgit Willinger, Marjan Wouthuyzen-Bakker, Brianne Couturier, and Florence Allantaz
J. Bone Joint Infect., 9, 87–97, https://doi.org/10.5194/jbji-9-87-2024, https://doi.org/10.5194/jbji-9-87-2024, 2024
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This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
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Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
Related subject area
Subject: Prosthesis-related infections | Topic: Diagnosis
Multiplex PCR test as an intra-operative diagnostic tool for periprosthetic joint infection in presumed aseptic revision hip and knee arthroplasty: a 1-year follow-up study of 200 cases
Hip aspiration culture: analysing data from a single operator series investigating periprosthetic joint infection
Thomas J. A. van Schaik, Petra J. C. Heesterbeek, Job L. C. van Susante, Wim H. C. Rijnen, and Jon H. M. Goosen
J. Bone Joint Infect., 9, 9–16, https://doi.org/10.5194/jbji-9-9-2024, https://doi.org/10.5194/jbji-9-9-2024, 2024
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This study evaluated the use of an automated custom-made multiplex PCR (mPCR) test of synovial fluid in presumed aseptic revision hip and knee arthroplasties. Of all 200 patients, none developed a periprosthetic joint infection (PJI) within the first year after surgery. The study showed that a positive mPCR test did not have value for prediction of PJI development. Therefore, the authors do not recommend using this test in presumed aseptic hip or knee revision surgery.
Connor J. Barker, Alan Marriot, Munir Khan, Tamsin Oswald, Samuel J. Tingle, Paul F. Partington, Ian Carluke, and Mike R. Reed
J. Bone Joint Infect., 6, 165–170, https://doi.org/10.5194/jbji-6-165-2021, https://doi.org/10.5194/jbji-6-165-2021, 2021
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Periprosthetic joint infection (PJI) is associated with increased morbidity and mortality but can be difficult to diagnose. Our aim is to analyse common diagnostic tests, specifically joint aspiration culture performed for suspected PJI by a single practitioner. We suggest that hip aspiration culture performs similarly to less invasive tests to rule out infection, recommend caution in interpreting a positive culture and suggest that hip aspiration should be used only with other synovial tests.
Cited articles
Berbari, E. F., Hanssen, A. D., Duffy, M. C., Steckelberg, J. M., Ilstrup, D. M., Harmsen, W. S., and Osmon, D. R.: Risk Factors for Prosthetic Joint Infection: Case-Control Study, Clin. Infect. Dis., 27, 1247–1254, 1998.
National Healthcare Safety Network: Surgical Site Infection Event (SSI) , available at:
https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf, last access: 3 November 2021.
Ziv, Y. B., Kardosh, R., Debi, R., Backstein, D., Safir, O., and Kosashvili, Y.: An Inexpensive and Accurate Method for Hip Injections Without the Use of Imaging, J. Clin. Rheumatol., 15, 103–105, 2009.
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We report on an 83-year-old woman who had an open removal of a baker's cyst several months after total knee arthroplasty. The following wound healing problem was first misinterpreted as being superficial. With an injection of methylene blue and a contrast medium, we showed the extent of the sinus tract, proving the periprosthetic joint infection.
We report on an 83-year-old woman who had an open removal of a baker's cyst several months after...