Utility of Synovial White Blood Cell Count and Differential Before Reimplantation Surgery

Zmistowski, Benjamin; Clyde, Corey T.; Ghanem, Elie; Gotoff, James R.; Deirmengian, Carl; Parvızı, Javad

doi:10.1016/j.arth.2017.03.068

Cited by 38 publications

(35 citation statements)

References 24 publications

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“…Irrespectively, whether IA was performed at the hip or at the knee Hoell et al calculated the best sensitivity at a cut-off value of only 960 cells/μl with a sensitivity of 31.3%, but at the expense of a very low specificity of 39.1% [ 15 ]. Comparable low sensitivity and specificity for SLC was found by Zmistowski et al [ 17 ]. However, derived from the data of primary PPI diagnosis, the different presuppositions at the knee in contrast to the hip in order to determine the best cut-off values should be considered [ 9 , 12 , 18 ].…”

Section: Discussionmentioning

confidence: 69%

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Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Boelch¹,

Weißenberger²,

Spohn³

et al. 2018

J Orthop Surg Res

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BackgroundEvaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated.MethodsNinety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed.ResultsThe sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671).ConclusionsSynovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.

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Section: Discussionmentioning

confidence: 69%

“…In comparison to the categorical SFC, the cut-off value of the metric SLC can be leveled up or down. It is evident that persistent infection can produce significantly higher SLC at IA [ 17 ]. However, the best cut-off values for SLC are still to be discussed [ 8 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Boelch¹,

Weißenberger²,

Spohn³

et al. 2018

J Orthop Surg Res

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show abstract

“…Additionally, more complex infection persistence definitions bear the risk of lacking traceability [ 13 , 15 ]. In accordance with other authors, we defined infection persistence as detection of the same pathogen in at least two intraoperative cultures or detection of a virulent pathogen in a single [ 12 , 16 , 20 ]. But still, derived from the results of PJI diagnosis, infection can occur without pathogen detection in up to 24% [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Follow-up studies could confirm the low sensitivity of IA on the bases of reinfection, instead of clinical, microbiological, and histopathological findings at planned reimplantation. Zmistowski et al defined infection persistence amongst other features by the need for septic revision due to same causative organism and reported a sensitivity of only 44% for the SWBCC [ 16 ]. However, under consideration of the statistic frequencies of causative organisms this approach is also limited by the inability to discriminate infection recurrence to new infection.…”

Section: Discussionmentioning

confidence: 99%

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Synovial Fluid Aspiration Should Not Be Routinely Performed during the Two-Stage Exchange of the Knee

Boelch

Roth

Arnholdt

et al. 2018

BioMed Research International

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Purpose Detection of infection persistence during the two-stage exchange of the knee for periprosthetic joint infection is challenging. Synovial fluid culture (SFC) and synovial white blood cell count (SWBCC) before joint reimplantation are widespread diagnostic means for this indication. The sensitivity and specificity of SFC and of SWBCC for infection persistence before planned reimplantation were evaluated. Methods 94 two-stage exchanges of the knee with synovial fluid aspiration performed after a drug holiday of at least 14 days and before reimplantation or spacer exchange (planned reimplantation) were retrospectively analyzed. Only cases with at least 3 intraoperative samples at planned reimplantation were included. SFC and SWBCC were compared to pathogen detection (SFC(culture)/SWBCC(culture)) and to histopathological signs of infection persistence (SFC(histo)/SWBCC(histo)) from intraoperative samples at planned reimplantation. For SFC, the sensitivity and specificity were calculated. For SWBCC, the optimal cut-off value with its sensitivity and specificity was calculated with the Youden-Index. Results Sensitivity and specificity of SFC(culture) were 0.0% and 98.9%. Sensitivity and specificity of SFC(histo) were 3.4% and 100%. The optimal cut-off value for SWBCC(culture) was 4450 cells/μl with a sensitivity of 50.0% and a specificity of 86.5%. The optimal cut-off value for SWBCC(histo) was 3250 cells/μl with a sensitivity of 35.7% and a specificity of 92.9%. Conclusion The detection of infection persistence remains challenging and a consented approach is lacking. The results do not warrant the routine performance of SFC during the two-stage exchange at the knee. SWBCC can be used to confirm infection persistence at high cut-offs, but they only occur in few patients and are therefore inappropriate for the routine use.

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Two-Stage Revision Arthroplasty for Periprosthetic Knee Infection

Longo

Salvatore

Candela

et al. 2021

Infection in Knee Replacement

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Utility of Synovial White Blood Cell Count and Differential Before Reimplantation Surgery

Cited by 38 publications

References 24 publications

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Synovial Fluid Aspiration Should Not Be Routinely Performed during the Two-Stage Exchange of the Knee

Two-Stage Revision Arthroplasty for Periprosthetic Knee Infection

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