Fig. 2
Flowchart of suspected late chronic PJI.
1Difficult to treat: chinolon resistant Gram-negative rods, rifampin-resistent Staphylocci, Enterococci, fungi and yeasts. 2In order to avoid secondary spacer infections with coagulase-negative Staphylococci [10]. 3For example in case of positive histology. 4Consider a nuclear bone or white blood cell scintigraphy if available. A bone scintigraphy is advised as a first step if the patient is > 5 years after the index surgery for knees and > 2 years for hips; when the affected prosthesis is younger, a white blood cell scintigraphy can be considered. If the bone scintigraphy is negative, infection is practically ruled out and no additional scans are needed. If the bone scan is positive, a white blood cell scintigraphy should be considered as it is more specific in diagnosing infection. If the white blood cell scintigraphy is negative, an infection is highly unlikely; if it is positive, cultures and histology should be performed as indicated above