White cell scans and infected joint replacements. Failure to detect chronic infection

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

“…Of the three patients with rheumatoid arthritis with aseptic loosening, two had elevated CRP levels greater than 10 mg/L. Second, the fluid cell count of the aspirated synovial fluid, which also seems to be a sensitive diagnostic tool for PJI, was not performed in our study [1,12,20]. The reason for this was because the volume of fluid obtained from the aspiration was not always sufficient for both investigations (bacteriologic analysis and cell count) to be performed.…”

“…Aspiration allows precise identification of bacteria and their antibiotic resistance pattern and provides information for planning antibiotic therapy before surgery. It also gives the surgeon the opportunity to add bacteriaspecific antibiotics to the bone cement during one-stage or two-stage revision operations [5,13,15,16,20,29,30,47,49]. However, the literature reveals a large variance in the diagnostic value of this method.…”

Infected total hip arthroplasty - the value of intraoperative histology

“…Scintigraphic examination with Tc-99 MDP has been commonly recognized as having a low specificity [3,4,9] in diagnosing infection, owing to unspecific increased uptake in noninfected arthroplasties more than 6 months after surgery. Scintigraphy with 111-indium oxine-labelled cells and with Tc-99 HmPAC white blood cells seemed to be good diagnostic tests [12,15,17,21,25,26], although other authors have reported a limited role for them in the detection of infection in a THA [14,29]. Joint aspiration is not exempt from problems, such as pain and risk of infection [2,9,10].…”

“…Intraoperative histological examination (IH) can be used to distinguish septic from aseptic loosening. It may especially be helpful when the results of clinical examination and preoperative tests are not sufficiently unequivocal [1,2,14,16,17,23,24,28]. A prospective study was performed to compare the sensitivity and the specificity of IH with other tests in diagnosing the presence of infection in THA.…”

Painful knee arthroplasty: current practice

“…Nuclear imaging has been confirmed to be effective by some authors [56]; for the low cost-effectiveness ratio, it is excluded from the standard workout [53•].…”