Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition

Purpose. Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was evaluated for the different PJI definitions. Methods. 256 THA revisions were retrospectively classified to be infected or not infected. Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS). Only chronic PJIs were included. Results. PJI prevalence at revision significantly correlated with the applied PJI definition ( p = 0.01 , Cramer’s V = 0.093 ). PJI prevalence was 20.7% for the MSIS, 25.4% for the ICM, 28.1% for the IDSA, and 32.0% for the EBJIS definition. For synovial fluid white blood cell count, the best ROC-AUC for predicting PJI was 0.953 in combination with the MSIS definition. Conclusion. PJI definition significantly influences the rate of diagnosed PJIs at THA revision. Synovial fluid white blood cell count is a reliable means to rule out PJI. In cases with a borderline high synovial white blood cell count before THA revision as the only sign of chronic PJI, an extended diagnostic work-up should be considered.

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AB0015 Synovial fluid analysis: correlation between reagent strips analysis and white blood cell count

10.1136/annrheumdis-2001.814 ◽

2001 ◽

Author(s):

S Aloui ◽

H Ben Frej ◽

S Chatti ◽

I Hadda ◽

I Bouajina ◽

...

Keyword(s):

Synovial Fluid ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Blood Cell Count ◽

Fluid Analysis ◽

Synovial Fluid Analysis ◽

Reagent Strips

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Defining a Synovial Fluid White Blood Cell Count Threshold to Predict Periprosthetic Infection after Shoulder Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm11010050 ◽

2021 ◽

Vol 11 (1) ◽

pp. 50

Author(s):

Laura Elisa Streck ◽

Chiara Gaal ◽

Johannes Forster ◽

Christian Konrads ◽

Sebastian Philipp von Hertzberg-Boelch ◽

...

Keyword(s):

Synovial Fluid ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Shoulder Arthroplasty ◽

Blood Cell Count ◽

Specific Data ◽

Joint Infections ◽

Shoulder Infection

Background: The diagnosis of periprosthetic shoulder infection (PSI) requires a thorough diagnostic workup. Synovial fluid aspiration has been proven to be a reliable tool in the diagnosis of joint infections of the lower extremity, but shoulder specific data is limited. This study defines a threshold for synovial fluid white blood cell count (WBC) and assesses the reliability of microbiological cultures. Methods: Retrospective study of preoperative and intraoperative fluid aspiration of 31 patients who underwent a revision of a shoulder arthroplasty (15 with PSI defined by IDSA criteria, 16 without infection). The threshold for WBC was calculated by ROC/AUC analysis. Results: WBC was significantly higher in patients with PSI than in other patients. A threshold of 2800 leucocytes/mm3 showed a sensitivity of 87% and a specificity of 88% (AUROC 0.92). Microbiological cultures showed a sensitivity of 76% and a specificity of 100%. Conclusions: A threshold of 2800 leucocytes/mm3 in synovial fluid can be recommended to predict PSI. Microbiological culture has an excellent specificity and allows for targeted antibiotic therapy. Joint aspiration presents an important pillar to diagnose PSI.

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Brief Report: Synovial Fluid White Blood Cell Count in Knee Osteoarthritis: Association With Structural Findings and Treatment Response

Arthritis & Rheumatology ◽

10.1002/art.39829 ◽

2016 ◽

Vol 69 (1) ◽

pp. 103-107 ◽

Cited By ~ 16

Author(s):

Paul S. McCabe ◽

Matthew J. Parkes ◽

Nasimah Maricar ◽

Charles E. Hutchinson ◽

Anthony Freemont ◽

...

Keyword(s):

Synovial Fluid ◽

Blood Cell ◽

Knee Osteoarthritis ◽

Cell Count ◽

Treatment Response ◽

White Blood Cell Count ◽

White Blood Cell ◽

Blood Cell Count

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Screening Patients Undergoing Total Hip or Knee Arthroplasty with Perioperative Urinalysis and the Effect of a Practice Change on Antimicrobial Use

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.272 ◽

2016 ◽

Vol 38 (3) ◽

pp. 281-286 ◽

Cited By ~ 6

Author(s):

Samuel Bailin ◽

Nicolas Noiseux ◽

Jean M. Pottinger ◽

Birgir Johannsson ◽

Ambar Haleem ◽

...

Keyword(s):

Cohort Study ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Blood Cell Count ◽

Total Hip ◽

Number Of Patients ◽

Prosthetic Joint Infections ◽

Tract Infections

OBJECTIVETo identify predictors of treatment for urinary tract infections (UTI) among patients undergoing total hip (THA) or knee (TKA) arthroplasties and to assess an intervention based on these predictors.DESIGNWe conducted a retrospective cohort study of 200 consecutive patients undergoing THA/TKA between February 21, 2011, and June 30, 2011, to identify predictors of treatment for UTI and a prospective cohort study of 50 patients undergoing these procedures between May 21, 2012, and July 17, 2012, to assess the association of signs or symptoms and UTI treatment. We then conducted a before-and-after study to assess whether implementing an intervention affected the frequency of treatment for UTI before or after THA/TKA.SETTINGThe orthopedics department of a university health center.PATIENTSPatients undergoing THA or TKA.INTERVENTIONSurgeons revised their UTI screening and treatment practices.RESULTSPositive leukocyte esterase (P<.0001; P<.0001) and urine white blood cell count>5 (P=.01; P=.01) were associated with preoperative or postoperative UTI treatment. In the prospective study, 12 patients (24%) had signs and symptoms consistent with UTI. The number of patients treated for presumed UTI decreased 80.2% after the surgeons changed their practices, and surgical site infection (SSI) rates, including prosthetic joint infections (PJIs), did not increase.CONCLUSIONSUrine leukocyte esterase and white blood cell count were the strongest predictors of treatment for UTI before or after THA/TKA. The intervention was associated with a significant decrease in treatment for UTI, and SSI/PJI rates did not increase.Infect Control Hosp Epidemiol 2017;38:281–286

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