Serum D-lactate, a novel serological biomarker, is promising for the diagnosis of periprosthetic joint infection

Table 1 MSIS Criteria for the Diagnosis of PJI and Thresholds for the Minor Diagnostic Criteria^a

		Recommended Threshold
Major criteria	(1) Two positive periprosthetic cultures with phenotypically identical microorganisms or (2) A sinus tract communicating with the joint
Minor criteria	(1) Elevated serum CRP and ESR	10 mg/L, 30 mm/h
	(2) Elevated SF WBC count or changes in the leukocyte esterase strip	3,000 cells/μl, + or ++
	(3) Elevated SF PMN%	80%
	(4) Positive histological analysis of the periprosthetic tissue	>5 neutrophils per high-power
	(5) A single positive culture	field in 5 high-power fields (×400)

^aPJI is present when 1 of the major criteria, or 3 of 5 of the minor criteria, are met. MSIS Musculoskeletal Infection Society, CRP C-reactive protein, ESR Erythrocyte sedimentation rate, SF Synovial fluid, WBC White blood cell, PMN% Polymorphonuclear neutrophil percentage

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