scholarly journals Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection

2020 ◽  
Vol 1 (12) ◽  
pp. 737-742
Author(s):  
René Mihalič ◽  
Jurij Zdovc ◽  
Peter Brumat ◽  
Rihard Trebše
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Predictive Performance ◽  
Sinus Tract ◽  
Histopathological Analysis ◽  
Polymorphonuclear Cells ◽  
Level Of Evidence ◽  
Wbc Count ◽  
Sensitivity Specificity

Aims Synovial fluid white blood cell (WBC) count and percentage of polymorphonuclear cells (%PMN) are elevated at periprosthetic joint infection (PJI). Leucocytes produce different interleukins (IL), including IL-6, so we hypothesized that synovial fluid IL-6 could be a more accurate predictor of PJI than synovial fluid WBC count and %PMN. The main aim of our study was to compare the predictive performance of all three diagnostic tests in the detection of PJI. Methods Patients undergoing total hip or knee revision surgery were included. In the perioperative assessment phase, synovial fluid WBC count, %PMN, and IL-6 concentration were measured. Patients were labeled as positive or negative according to the predefined cut-off values for IL-6 and WBC count with %PMN. Intraoperative samples for microbiological and histopathological analysis were obtained. PJI was defined as the presence of sinus tract, inflammation in histopathological samples, and growth of the same microorganism in a minimum of two or more samples out of at least four taken. Results In total, 49 joints in 48 patients (mean age 68 years (SD 10; 26 females (54%), 25 knees (51%)) were included. Of these 11 joints (22%) were infected. The synovial fluid WBC count and %PMN predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 82%, 97%, 94%, 90%, and 95%, respectively. Synovial fluid IL-6 predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 73%, 95%, 90%, 80%, and 92%, respectively. A comparison of predictive performance indicated a strong agreement between tests. Conclusions Synovial fluid IL-6 is not superior to synovial fluid WBC count and %PMN in detecting PJI. Level of Evidence: Therapeutic Level II Cite this article: Bone Jt Open 2020;1-12:737–742.

scholarly journals Factors to Consider When Assessing the Diagnostic Accuracy of Synovial Leukocyte Count in Periprosthetic Joint Infection

2019 ◽  
Vol 4 (4) ◽  
pp. 167-173 ◽  
Author(s):  
Karsten D Ottink ◽  
Carol Strahm ◽  
Anneke Muller-Kobold ◽  
Parham Sendi ◽  
Marjan Wouthuyzen-Bakker
Keyword(s):  
Synovial Fluid ◽  
Blood Cell ◽  
Diagnostic Accuracy ◽  
Periprosthetic Joint Infection ◽  
Leukocyte Count ◽  
Joint Infection ◽  
Polymorphonuclear Leucocytes ◽  
Causative Microorganism ◽  
Wbc Count ◽  
Morbid Conditions

Abstract. Synovial white blood cell (WBC) count and the percentage of polymorphonuclear leucocytes (PMN%) is one of the diagnostic criteria to diagnose a periprosthetic joint infection (PJI). Although the test is widely available, the diagnostic accuracy of proposed cut-off levels are influenced by several factors, such as: the affected joint, co-morbid conditions, the causative microorganism and the gathering and processing of samples in the laboratory. In this narrative review we provide an overview on how and to what extent these factors can affect the synovial WBC count and PMN% in synovial fluid.

scholarly journals Reliability of synovial fluid alpha-defensin and leukocyte esterase in diagnosing periprosthetic joint infection (PJI): a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yisheng Chen ◽  
Xueran Kang ◽  
Jie Tao ◽  
Yunpeng Zhang ◽  
Chenting Ying ◽  
...  
Keyword(s):  
Systematic Review ◽  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Meta Analysis ◽  
Joint Infection ◽  
High Specificity ◽  
Diagnostic Efficiency ◽  
Operating Characteristics ◽  
Musculoskeletal Infection ◽  
Sensitivity Specificity

Abstract Background Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI. Methods We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis. Results After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84–90%), 96% (95% CI 95–97%), and 170.09 (95% CI 97.63–296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83–90%), 97% (95% CI 96–98%), and 158.18 (95% CI 74.26–336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively. Conclusion Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.

Saline lavage after a “dry tap”

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 138-144 ◽  
Author(s):  
Nathanael D. Heckmann ◽  
Cindy R. Nahhas ◽  
JaeWon Yang ◽  
Craig J. Della Valle ◽  
Paul H. Yi ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Lavage Fluid ◽  
Mean Difference ◽  
Polymorphonuclear Cells ◽  
Musculoskeletal Infection ◽  
Wbc Count ◽  
The Impact ◽  
Saline Lavage

Aims In patients with a “dry” aspiration during the investigation of prosthetic joint infection (PJI), saline lavage is commonly used to obtain a sample for analysis. The aim of this study was to investigate prospectively the impact of saline lavage on synovial fluid analysis in revision arthroplasty. Methods Patients undergoing revision hip (THA) or knee arthroplasty (TKA) for any septic or aseptic indication were enrolled. Intraoperatively, prior to arthrotomy, the maximum amount of fluid possible was aspirated to simulate a dry tap (pre-lavage) followed by the injection with 20 ml of normal saline and re-aspiration (post-lavage). Pre- and post-lavage synovial white blood cell (WBC) count, percent polymorphonuclear cells (%PMN), and cultures were compared. Results A total of 78 patients had data available for analysis; 17 underwent revision THA and 61 underwent revision TKA. A total of 16 patients met modified Musculoskeletal Infection Society (MSIS) criteria for PJI. Pre- and post-lavage %PMNs were similar in septic patients (87% vs 85%) and aseptic patients (35% vs 39%). Pre- and post-lavage synovial fluid WBC count were far more disparate in septic (53,553 vs 8,275 WBCs) and aseptic (1,103 vs 268 WBCs) cohorts. At a cutoff of 80% PMN, the post-lavage aspirate had a sensitivity of 75% and specificity of 95%. At a cutoff of 3,000 WBCs, the post-lavage aspirate had a sensitivity of 63% and specificity of 98%. As the post-lavage synovial WBC count increased, the difference between pre- and post-lavage %PMN decreased (mean difference of 5% PMN in WBC < 3,000 vs mean difference 2% PMN in WBC > 3,000, p = 0.013). Of ten positive pre-lavage fluid cultures, only six remained positive post-lavage. Conclusion While saline lavage aspiration significantly lowered the synovial WBC count, the %PMN remained similar, particularly at WBC counts of > 3,000. These findings suggest that in patients with a dry-tap, the %PMN of a saline lavage aspiration has reasonable sensitivity (75%) for the detection of PJI. Cite this article: Bone Joint J 2020;102-B(6 Supple A):138–144.

What Is the Best Technique for Performing Aspiration of Patients With Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 25S-26S
Author(s):  
Rachel Shakked
Keyword(s):  
Synovial Fluid ◽  
Ankle Joint ◽  
Periprosthetic Joint Infection ◽  
Ultrasound Guidance ◽  
Joint Infection ◽  
Synovial Fluid Sample ◽  
Fluid Sample ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Joint Aspiration

Recommendation: In the absence of evidence, we recommend that ankle joint aspiration to evaluate for periprosthetic joint infection (PJI) be performed under sterile conditions via the anteromedial approach. Ultrasound guidance may be used if available but is not necessary to obtain an acceptable synovial fluid sample. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

scholarly journals Combination of Synovial Fluid IL-4 and Polymorphonuclear Cell Percentage Improves the Diagnostic Accuracy of Chronic Periprosthetic Joint Infection

2021 ◽  
Author(s):  
Jiaxing Huang ◽  
Jiawei wang ◽  
Lei lei Qin ◽  
Bo Zhu ◽  
Sizheng Zhu ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Diagnostic Accuracy ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Diagnostic Value ◽  
Polymorphonuclear Cells ◽  
Polymorphonuclear Cell ◽  
Cell Percentage ◽  
Serum Crp

Abstract Background: Synovial fluid biomarkers have been confirmed with promising diagnostic value for chronic periprosthetic joint infection (PJI), even there was still no “gold standard”. Interleukin-4 (IL-4) and polymorphonuclear cells (neutrophil) count in synovial fluid play a crucial role in mediating local inflammation of bacterial infections and therefore could be valuable biomarkers for PJI. Methods: The purpose of this study was to investigate the diagnostic capacity of synovial fluid IL4 (SF-IL4) and polymorphonuclear cell percentage(SF-PMN%) for chronic PJI. According to the 2013 Musculoskeletal Infections Society(MSIS 2013) criteria, chronic PJI is defined as occurred more than 6 weeks after the primary arthroplasty. A total of 110 patients who scheduled to undergo revision arthroplasty from January 2019 to October 2020 were enrolled. 11 patients were eliminated by exclusion criteria. 43 of 99 patients were classified as infected and 56 as not infected. In all patients, SF-IL4 and SF-PMN% were measured in synovial fluid, serum CRP, ESR levels were measured preoperatively. The area under the curve(AUC) for each biomarker was analyzed, the diagnostic value and optimal cutoff values were calculated. Results: The demographic data was not statistically different. The SF-IL4 and SF-PMN% showed a great diagnostic accuracy of chronic PJI from aseptic failure patients with AUC of 0.97(95% confidence interval (CI), 0.92-0.99) and 0.89(95%CI, 0.82-0.95) separately, which was higher than the serum ESR (0.72), and serum CRP (0.83). We set 1.7 pg/mL and 75% as the optimal cut-off values of SF-IL4 and SF-PMN% individually. Combination of SF-IL4 and SF-PMN% improved the diagnostic ability for chronic PJI with a specificity of 97.0%, and 96.0% accuracy.Conclusion: Synovial fluid IL-4 was a valuable biomarker for chronic PJI detection. Combination of SF-IL4 and SF-PMN% provided higher specificity and accuracy when met the cut-off values of 1.7 pg/mL and 75% simultaneously.

Synovial fluid α defensin has comparable accuracy to synovial fluid white blood cell count and polymorphonuclear percentage for periprosthetic joint infection diagnosis

2021 ◽  
Vol 103-B (6) ◽  
pp. 1119-1126
Author(s):  
Morgan I. Ivy ◽  
Katyayini Sharma ◽  
Kerryl E. Greenwood-Quaintance ◽  
Aaron J. Tande ◽  
Douglas R. Osmon ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Blood Cell ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
White Blood Cell ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Polymorphonuclear Neutrophil ◽  
Enzyme Linked Immunosorbent Assay ◽  
Wbc Count

Aims The aim of this study was to determine the diagnostic accuracy of α defensin (AD) lateral flow assay (LFA) and enzyme-linked immunosorbent assay (ELISA) tests for periprosthetic joint infection (PJI) in comparison to conventional synovial white blood cell (WBC) count and polymorphonuclear neutrophil percentage (PMN%) analysis. Methods Patients undergoing joint aspiration for evaluation of pain after total knee arthroplasty (TKA) or total hip arthroplasty (THA) were considered for inclusion. Synovial fluids from 99 patients (25 THA and 74 TKA) were analyzed by WBC count and PMN% analysis, AD LFA, and AD ELISA. WBC and PMN% cutoffs of ≥ 1,700 cells/mm3 and ≥ 65% for TKA and ≥ 3,000 cells/mm3 and ≥ 80% for THA were used, respectively. A panel of three physicians, all with expertise in orthopaedic infections and who were blinded to the results of AD tests, independently reviewed patient data to diagnose subjects as with or without PJI. Consensus PJI classification was used as the reference standard to evaluate test performances. Results were compared using McNemar’s test and area under the receiver operating characteristic curve (AUC) analysis. Results Expert consensus classified 18 arthroplasies as having failed due to PJI and 81 due to aseptic failure. Using these classifications, the calculated sensitivity and specificity of AD LFA was 83.3% (95% confidence interval (CI) 58.6 to 96.4) and 93.8% (95% CI 86.2 to 98.0), respectively. Sensitivity and specificity of AD ELISA was 83.3% (95% CI 58.6 to 96.4) and 96.3% (95% CI 89.6 to 99.2), respectively. There was no statistically significant difference between sensitivity (p = 1.000) or specificity (p = 0.157) of the two AD assays. AUC for AD LFA was 0.891. In comparison, AUC for synovial WBC count, PMN%, and the combination of the two values was 0.821 (sensitivity p = 1.000, specificity p < 0.001), 0.886 (sensitivity p = 0.317, specificity p = 0.011), and 0.926 (sensitivity p = 0.317, specificity p = 0.317), respectively. Conclusion The diagnostic accuracy of synovial AD for PJI diagnosis is comparable and not statistically superior to that of synovial WBC count plus PMN% combined. Cite this article: Bone Joint J 2021;103-B(6):1119–1126.

scholarly journals The Concordance between Preoperative Aspiration and Intraoperative Synovial Fluid Culture Results: Intraoperative Synovial Fluid Re-Cultures Are Necessary whether the Preoperative Aspiration Culture is Positive or Not.

2021 ◽  
Author(s):  
Hao Li ◽  
Chi Xu ◽  
Libo Hao ◽  
Wei Chai ◽  
Jun Fu ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Positive Predictive Value ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Pathogen Identification ◽  
Culture Growth ◽  
Sensitivity Specificity ◽  
Synovial Fluid Culture ◽  
Fluid Culture

Abstract Aims: Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine 1）the discordance between preoperative and intraoperative synovial fluid (SF) culture and. 2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive?Materials and methods:Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed. Results:The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity.Conclusions: The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture.

scholarly journals The concordance between preoperative aspiration and intraoperative synovial fluid culture results: intraoperative synovial fluid re-cultures are necessary whether the preoperative aspiration culture is positive or not

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hao Li ◽  
Chi Xu ◽  
LiBo Hao ◽  
Wei Chai ◽  
Fu Jun ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Joint Infection ◽  
Pathogen Identification ◽  
Level Of Evidence ◽  
Culture Growth ◽  
Sensitivity Specificity ◽  
Synovial Fluid Culture ◽  
Fluid Culture

Abstract Aims Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine (1) the discordance between preoperative and intraoperative synovial fluid (SF) culture and. (2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive? Materials and methods Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed. Results The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity. Conclusions The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture. Level of evidence: Level III.

Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 3S-4S
Author(s):  
Ilker Uçkay ◽  
Christopher B. Hirose ◽  
Mathieu Assal
Keyword(s):  
Periprosthetic Joint Infection ◽  
Corticosteroid Injection ◽  
Joint Infection ◽  
Invasive Procedure ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Strong Consensus ◽  
Healthcare Associated ◽  
The Ideal

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

scholarly journals Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 434
Author(s):  
Frank Sebastian Fröschen ◽  
Sophia Schell ◽  
Matthias Dominik Wimmer ◽  
Gunnar Thorben Rembert Hischebeth ◽  
Hendrik Kohlhof ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Multiple Regression ◽  
Complement System ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Expression Patterns ◽  
Factor H ◽  
Low Grade ◽  
Complement Factors ◽  
Fluid Levels

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

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