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

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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Diagnosing joint infections: synovial fluid differential is more sensitive than white blood cell count

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-013-1331-x ◽

2013 ◽

Vol 24 (8) ◽

pp. 1469-1474 ◽

Cited By ~ 7

Author(s):

Sean Baran ◽

Connie Price ◽

David J. Hak

Keyword(s):

Synovial Fluid ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Blood Cell Count ◽

Joint Infections

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

BioMed Research International ◽

10.1155/2021/8442435 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Sebastian Philipp Boelch ◽

Kilian Rückl ◽

Laura Elisa Streck ◽

Viktoria Szewczykowski ◽

Manuel Weißenberger ◽

...

Keyword(s):

Synovial Fluid ◽

Total Hip Arthroplasty ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Hip Arthroplasty ◽

Joint Infection ◽

Blood Cell Count ◽

Total Hip

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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