If a microorganism of low-virulence was detected in the preoperative aspiration culture, it may be necessary to perform an intra-op synovial fluid culture to further identify the specific PJI pathogen. If a microorganism of high-virulence was detected in the preoperative aspiration culture, there may be no need to perform intra-op synovial fluid culture again because the PJI pathogen has been identified and extra tests increase the cost of PJI management. However, according to these criteria, a problem was raised: are intraoperative synovial fluid re-cultures necessary if preoperative aspiration culture is positive. If a microorganism of low virulence was detected in a single specimen, PJI was highly suspected. If a microorganism of high virulence was revealed in a single specimen from the patients, the PJI was diagnosed. Based on the EBJIS criteria of periprosthetic joint infection, both synovial fluid and at least five reliable tissue samples must be obtained using separate instruments and immediately transferred to the laboratory for culture. However, to our knowledge, some studies revealed the difference between preoperative aspiration cultures and intraoperative tissue cultures but no studies comprehensively evaluated the concordance between preoperative aspiration culture and intraoperative synovial fluid culture. Preoperative joint aspiration is pivotal in the management of PJI patients because the preoperative identification of PJI pathogens and subsequent antibiotics sensitivity test (AST) can guide perioperative antibiotics administration and the selection of optimal surgery method. Identifying the offending pathogens in PJI patients is critical in initiating early antibiotic administration, choosing optimal surgical management strategy, and predicting prognosis. Unfortunately, the incidence of PJI is increasing but the diagnosis and treatment of PJI remain challenging and controversial. Periprosthetic joint infection (PJI), is a serious complication after total joint arthroplasties (TJA) and lays a huge burden on patients, surgeons, and healthcare systems worldwide. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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