Table 3.

Outcomes of culture-negative periprosthetic joint infection

Study	Time period	Number of cases	Definition of PJI	I&D infection-free survival rate	Two-stage revision infection-free survival rate	Followup	Antibiotic therapy (culture-negative cases)
Berbari et al. [3]	January 1990 to December 1999	60 (7%)	Intraoperative purulence or Positive histopathology or sinus tract communicating with prosthesis	71%	94%	5 years	Cephalosporins (82%) Vancomycin (12%) Other (6%)
Malekzadeh et al. [13]	January 1985 to December 2000	135 (10.6%)	Intraoperative purulence or positive histopathology or sinus tract communicating with prosthesis	78%	78%	Median 4.6 years (range, 1 day to 22 years)	Cefazolin (69%) Vancomycin (13%) None or other (18%)
Bejon et al. [2]	January 1999 to April 2003	62 (41%)	Persistent sinus tract or positive histology	Not Available	Overall success of 83% similar in culture positive and negative cases	Mean 5.75 years	Glycopeptides (100%)
Current study	January 2000 to December 2007	48 (11.9%)	Two positive cultures or sinus tract communicating with prosthesis or 4 of 5 of the following: (1) elevated ESR or CRP; (2) elevated Synovial fluid white cell count; (3) elevated synovial fluid PMN%; (4) one positive culture; (5) intraoperative purulence	6/12 (50%)	19/27 (70%)	Mean 3.9 years (range, 1.0–9.9 years)	Vancomycin (81%) Cephalosporins (10%) Other (9%)

PJI = periprosthetic joint infection; I&D = irrigation and débridement; ESR = erythrocyte sedimentation rate; CRP = C-reactive protein; PMN = polymorphonuclear cells.