2026 AAHKS Annual Meeting: Same-Specimen NGS Vs. Culture and Biomarkers for Diagnosing PJI from Aspirated Synovial Fluid

569 preoperative hip and knee synovial fluid aspirates were evaluated to compare next-generation sequencing (NGS), conventional microbial culture, and established synovial biomarkers for diagnosing periprosthetic joint infection (PJI). Each specimen was divided for parallel testing, allowing direct comparisons between diagnostic methods. The primary outcomes were diagnostic sensitivity, specificity, and accuracy using the 2018 International Consensus Meeting (ICM) criteria as the reference standard. Secondary outcomes included microbial detection breadth and the diagnostic performance of combined testing strategies involving C-reactive protein (CRP), white blood cell count (WBC), and polymorphonuclear neutrophils (PMN). Testing was performed preoperatively, with no longitudinal follow-up reported. Overall, the results revealed that NGS demonstrated substantially higher sensitivity than culture, with comparable specificity and accuracy. These findings suggested that incorporating NGS into composite diagnostic algorithms may improve preoperative identification of PJI.