Diagnostics of shoulder periprosthetic joint infections: a global survey

Background: Diagnosing shoulder periprosthetic joint infections is challenging. Several diagnostic tests are available, but their predictive value varies and is often poor. The aims of this study were to assess internationally how shoulder surgeons diagnose periprosthetic joint infections, and to investigate if there are intercollegiate and intercontinental differences. Methods: An online survey was designed for shoulder surgeons, incorporating questions regarding their utilization of various diagnostic tests and their level of professional experience. The survey was sent digitally to all members of the European Society for Surgery of the Shoulder and the Elbow, all European National Delegates, and 10 other Shoulder and Elbow societies worldwide. Results: Two hundred thirty-nine surveys were included in this study. The majority of the respondents (≥65%) routinely use at least 9 of different diagnostic tests as a workup for a shoulder periprosthetic joint infections: blood testing (C-reactive protein, white blood cell count, and erythrocyte sedimentation rate), pre-revision synovial fluid aspiration (culture, white blood cell count and neutrophil percentage), intraoperative synovial fluid aspiration (culture), pre-revision tissue biopsy for culture, and tissue biopsy for culture during revision surgery. Significantly more cultures were taken by respondents who perform fewer revisions (P = .008). These surgeons are also less likely to rely solely on cultures to diagnose an infection of the periprosthetic joint of the shoulder. Respondents outside Europe use frozen section and sonication significantly less often (P < .001), and more often erythrocyte sedimentation rate (P = .001) and Metal Artifact Reduction Sequence magnetic resonance imaging (P = .01)), compared to respondents in Europe. Conclusion: The majority of those who responded to the survey use at least 9 different tests to diagnose shoulder periprosthetic joint infections. Respondents who perform fewer revisions take more cultures, and are less likely to rely solely on these results, compared to surgeons who perform more revisions. There are several intercontinental differences in the use of diagnostic tests (within Europe and beyond).