A comprehensive review of the diagnosis and management of prosthetic joint infections in the absence of positive cultures.

The diagnosis and management of prosthetic joint infections (PJI) with negative cultures remains an enigma without clear definitions and guidelines for its management. In contrast, the literature offers guidelines to the diagnosis and management of culture positive prosthetic joint infections as noted in both the infectious disease literature and the orthopedic literature. This paper outlines the current state of knowledge of PJI with negative cultures and summarizes the recommendations for the work up and management of this condition. In addition, we propose a simple algorithm that clinicians may find useful for the management of PJI with negative cultures. This algorithm has not been validated with data at this point, but can be applied to practice to help direct the management and diagnosis of prosthetic joint infections in the absence of positive cultures.