Can the Leukocyte Esterase Strip Test Predict Persistence of Periprosthetic Joint Infection at Second-Stage Reimplantation?

Logoluso, Nicola; Pellegrini, Antonio; Suardi, Virginia; Morelli, Ivano; Battaglia, Antonino Giulio; D’Anchise, Roberto; Vecchi, Elena De; Zagra, Luigi

doi:10.1016/j.arth.2021.11.022

Cited by 11 publications

(4 citation statements)

References 38 publications

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“…Previous studies have shown that serological markers such as C-reactive protein (CRP) and erythrocyte sedimentation (ESR) are unreliable markers for evaluating the persistence of reimplantation infection (George et al, 2016;Fu et al, 2018). More recently, it has been proposed that the LE strip test can be used as a reliable tool for diagnosing the persistence of infection and outperforming the serum CRP and ESR assays (Logoluso et al, 2022). However, patients in the cohort of this study were followed for less than two years after replantation which is the same as in our study, justifying the necessity of long-term.…”

Section: Discussionmentioning

confidence: 99%

“…While this threshold may change as data from different institutions increases, it is a good starting point and a guide for clinicians wishing to use this test. Finally, there is no doubt that the study of the timing of reimplantation in two-stage revision surgery is the most concerned topic in orthopedic infections (Shahi et al, 2017;Logoluso et al, 2022). We evaluated the appearance of inguinal lymph nodes in patients undergoing reimplantation for treatment of PJI, and there were no recurrent cases of infection in existing follow-up, although long-term follow-up results were lacking.…”

Section: Discussionmentioning

confidence: 99%

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Detection of inguinal lymph nodes is promising for the diagnosis of periprosthetic joint infection

Qin

Zhao

Wang

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundLocalized inguinal lymphadenopathy often represents lower extremity pathogen infection, while normalized lymphadenopathy is associated with infection regression. We hypothesized that inguinal lymph nodes (LNs) were enlarged in Periprosthetic Joint Infection (PJI) patients and that normalized inguinal LNs would be a promising way to determine the timing of reimplantation.MethodsWe prospectively enrolled 176 patients undergoing primary and revision hip or knee arthroplasty. All patients underwent ultrasound examination of inguinal LNs preoperatively. The diagnostic value of inguinal LNs in PJI was evaluated by the receiver operating characteristic (ROC) curve.ResultsThe median level of inguinal LNs was 26mm in the revision for PJI group compared with 12 mm in the aseptic revision group (p< 0.0001). The size of the inguinal LNs well distinguishes PJI from aseptic failure (AUC= 0.978) compare with ESR (AUC= 0.707) and CRP (AUC= 0.760). A size of 19mm was determined as the optimal threshold value of the inguinal LNs for the diagnosis of PJI, with a sensitivity of 92% and specificity of 96%.ConclusionUltrasonic analysis of inguinal LNs is a valuable piece of evidence for the diagnosis of PJI and evaluation of persistent infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Detection of inguinal lymph nodes is promising for the diagnosis of periprosthetic joint infection

Qin

Zhao

Wang

et al. 2023

Front. Cell. Infect. Microbiol.

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“…It could be due to several factors, but a possible reason for this unsatisfactory outcome is the difficulty in evaluating persistent infection before second-stage surgery. A diagnostic gold standard test to determine the infection persistence at reimplantation in fact is still missing: to this end, the synovial leucocyte esterase strip test seems to be a promising intra-operative diagnostic tool, beyond serum CRP and ESR assays [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Megaprostheses for the revision of infected hip arthroplasties with severe bone loss

et al. 2022

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Background Periprosthetic hip infections with severe proximal femoral bone loss may require the use of limb salvage techniques, but no agreement exists in literature regarding the most effective treatment. Aim of this study is to analyze the infection eradication rate and implant survival at medium-term follow-up in patients treated with megaprostheses for periprosthetic hip infections with severe bone loss. Methods Twenty-one consecutive patients were retrospectively reviewed at a mean 64-month follow-up (24–120). Functional and pain scores, microbiological, radiological and intraoperative findings were registered. Kaplan Meier survival analysis and log rank test were used for infection free survival and implant survival analyses. Results The infection eradication rate was 90.5%, with an infection free survival of 95.2% at 2 years (95%CI 70.7–99.3) and 89.6%(95%CI 64.3–97.3) at 5 years. Only two patients required major implant revisions for aseptic implant loosening. The most frequent complication was dislocation (38.1%). The major revision-free survival of implants was 95.2% (95%CI 70.7–99.3) at 2 years and 89.6% (95%CI 64.3–97.3) at 5 years. The overall implant survival was 83.35% (CI95% 50.7–93.94) at 2 and 5 years. Subgroup analyses (cemented versus cementless MPs, coated versus uncoated MPs) revealed no significant differences at log rank test, but its reliability was limited by the small number of patients included. Conclusions Proximal femoral arthroplasty is useful to treat periprosthetic hip infections with severe bone loss, providing good functional results with high infection eradication rates and rare major revisions at medium-term follow-up. No conclusions can be drawn on the role of cement and coatings.

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“…The procedure is also difficult to perform with hip spacers present. The role of rapid testing of intraoperative joint fluid (e.g., leukocyte esterase strip test) holds promise for diagnosing persistent infection; however, studies in this regard are still few [ 8 , 9 , 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Reimplantation after Periprosthetic Joint Infection: The Role of Microbiology

et al. 2022

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Periprosthetic joint infection (PJI) is among the most feared orthopedic complications. Critical questions are whether the infection is completely resolved before reimplantation and what the clinical significance of positive culture is at reimplantation. The aim of this study was to determine whether a correlation exits between culture results at reimplantation after spacer insertion for hip and knee PJI and treatment failure rate. The data of 84 patients who underwent two-stage exchange arthroplasty for hip or knee PJI were reviewed and the results of intraoperative culture at reimplantation were analyzed quantitatively and qualitatively. Correlations were sought between these patterns and treatment outcome. Our data indicate no evidence for a correlation between positive culture at reimplantation and greater risk of treatment failure. Nonetheless, we noted a higher, albeit statistically not significant rate of treatment failure in patients with at least two samples testing positive. The role of microbiology at reimplantation remains unclear, but a positive culture might signal increased risk for subsequent implant failure. Further studies are needed to elucidate the implications of this finding.

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Can the Leukocyte Esterase Strip Test Predict Persistence of Periprosthetic Joint Infection at Second-Stage Reimplantation?

Cited by 11 publications

References 38 publications

Detection of inguinal lymph nodes is promising for the diagnosis of periprosthetic joint infection

Detection of inguinal lymph nodes is promising for the diagnosis of periprosthetic joint infection

Megaprostheses for the revision of infected hip arthroplasties with severe bone loss

Reimplantation after Periprosthetic Joint Infection: The Role of Microbiology

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