Analysis of existing approaches to determine culture‑negative periprosthetic infection of the hip and knee joints and assessment of its treatment outcomes

Introduction Periprosthetic infection is one of the most frequent and devastating complications after total hip replacement. The effectiveness of infection management depends on possibility of prescribing etiotropic antibiotics after the operation and the rational choice of a surgical technique. In 5–30 % of all patients the etiology of the infectious process remains unknown throughout the entire treatment period. Such cases are described by the term "culture-negative periprosthetic joint infection". Nowaday, there is no single definition for culture-negative PJI in the professional community.

The aim of this study is to evaluate the treatment results of patients with culture-negative periprosthetic infection, depending on the approach to its detection, as well as formulate possible ways to reduce its rates.

Methods Literature search was performed in electronic databases eLIBRARY, PubMed (MEDLINE), ScienceDirect, Google Scholar according to PRISMA recommendations. The study included articles in Russian and English, original articles and case series on the treatment of chronic culture-negative periprosthetic infection of the hip joint and/or knee joints in patients over 18 years of age using any surgical operations and in which there was at least one indicator of treatment effectiveness. The existing approaches to detection of culture-negative periprosthetic joint infection of the knee and hip and the outcomes of treatment of patients with this pathology were analyzed, as well as possible ways to reduce the number of patients with an unknown etiology of the infectious process were formulated.

Results and Discussion Our analysis of scientific publications revealed no clear difference in the effectiveness of  infection control depending on the approach to detection of culture-negative PJI. For the first time, the effectiveness of treatment for patients with culture-negative PJI is examined depending on the  approach to detection of this pathology. Significant heterogeneity was identified in both the interpretation of culture‑negative PJI and the choice of surgical techniques. The high rate of successful outcomes indicates the importance of appropriate selection of drugs for empirical antibiotic therapy (ABT) and regular monitoring of the spectrum of nosocomial pathogens. Potential ways to reduce the incidence of negative microbiological test results are proposed.

Conclusion The efficacy of treatment of culture-negative PJI did not differ significantly depending on the interpretation of this term. Ways to reduce the incidence of this pathology are aimed at modifying the factors that cause negative results of MBI of biomaterial samples and removed structures.

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