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The presence of a fistula or of local inflammatory signs is indicative of PJI, but in many cases local pain is the only symptom. In the absence of underlying inflammatory conditions, C-reactive protein measurement is the most useful preoperative blood test for detecting infection associated with a prosthetic joint. The most useful preoperative diagnostic test is the aspiration of synovial joint fluid to obtain a total and differential cell count and culture. Intraoperative frozen sections of periprosthetic tissues produce excellent accuracy in predicting a diagnosis of PJI but only moderate accuracy in ruling out the diagnosis. In this process, obtaining a quality sample is the first step, and determines the quality of microbiological results. Specimens for culture should be obtained prior to the initiation of antibiotic treatment. Sonication of a removed implant may increase the culture yield. Plain radiography has low sensitivity and low specificity for detecting infection associated with a prosthetic joint. Computed tomography and magnetic resonance imaging may be useful in the evaluation of complex cases, but metal inserts interfere with these tests, and abnormalities may be non-specific. Labelled-leucocyte imaging (e.g., leucocytes labelled with indium-111) combined with bone marrow imaging with the use of technetium-99m\u2013labelled sulphur colloid is considered the imaging test of choice when imaging is necessary.<\/jats:p>","DOI":"10.2174\/1874325001307010178","type":"journal-article","created":{"date-parts":[[2013,6,24]],"date-time":"2013-06-24T10:15:17Z","timestamp":1372068917000},"page":"178-183","update-policy":"https:\/\/doi.org\/10.2174\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["The Diagnosis of Periprosthetic Infection"],"prefix":"10.2174","volume":"7","author":[{"given":"Alfonso","family":"del Arco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Luisa","family":"Bertrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"965","reference":[{"key":"refR1","doi-asserted-by":"crossref","first-page":"963","DOI":"10.2106\/00004623-200405000-00012","volume":"86-A","author":"Ethgen O","year":"2004","unstructured":"Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY. 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