scholarly journals Accuracy of Synovial Leukocyte and Polymorphonuclear Cell Count in Patients with Shoulder Prosthetic Joint Infection

2018 ◽  
Vol 3 (5) ◽  
pp. 245-248 ◽  
Author(s):  
Carol Strahm ◽  
Vilijam Zdravkovic ◽  
Claus Egidy ◽  
Bernhard Jost
Keyword(s):  
Cell Count ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Leucocyte Count ◽  
Diagnostic Method ◽  
Joint Infection ◽  
Polymorphonuclear Cell ◽  
Joint Aspiration ◽  
Prosthetic Joint ◽  
Leukocyte Counts

Abstract. Joint aspiration in suspected infected implants is a validated diagnostic method in establishing the diagnosis of prosthetic joint infection (PJI). Cut-off values for synovial leukocyte counts and differentials are well described for patients with hip and knee PJI. In 19 failed shoulder implants, a leucocyte count of >12.2 G/L had a sensitivity and specificity of 92% and 100% respectively; A differential of >54% neutrophils had a sensitivity of 100 % and a specificity of 75%.

Joint aspiration, including culture of reaspirated saline after a ‘dry tap’, is sensitive and specific for the diagnosis of hip and knee prosthetic joint infection

2018 ◽  
Vol 100-B (6) ◽  
pp. 749-754 ◽  
Author(s):  
D. G. Partridge ◽  
C. Winnard ◽  
R. Townsend ◽  
R. Cooper ◽  
I. Stockley
Keyword(s):  
High Risk ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Saline Injection ◽  
Referral Centre ◽  
Specific Test ◽  
Joint Aspiration ◽  
Prosthetic Joint

AimsThe aim of this study was to establish the diagnostic accuracy of culture of joint aspirate with and without saline injection-reaspiration.Patients and MethodsThis is a retrospective analysis of 580 hip and knee aspirations in patients who were deemed to have a moderate to high risk of infection, and who subsequently proceeded to revision arthroplasty over a period of 12 years. It was carried out at a large quaternary referral centre where preoperative aspiration is routine.ResultsFluid was aspirated primarily in 313 (54%) cases and after saline injection-reaspiration of a ‘dry tap’ in 267 (46%) cases. Overall sensitivity and specificity of the diagnostic aspirate were 84% (78% to 89%) and 85% (81% to 88%), respectively. Sensitivity and specificity of saline injection-reaspiration after ‘dry tap’ were 87% (79% to 92%) and 79% (72% to 84%) compared with 81% (71% to 88%) and 90% (85% to 93%) for direct aspiration.ConclusionPreoperative joint aspiration and culture is a sensitive and specific test for the confirmation of diagnosis in patients at a moderate to high risk of prosthetic joint infection. Culture of saline injection-reaspiration also provides accurate diagnostic information in the event of a ‘dry tap’. Both methods allow susceptibility testing of relevant organisms and are therefore able to guide perioperative antibiotic therapy. Cite this article: Bone Joint J 2018;100-B:749–54.

scholarly journals Evaluation of a rapid lateral flow calprotectin test for the diagnosis of prosthetic joint infection

2019 ◽  
Author(s):  
Alexander J. Trotter ◽  
Rachael Dean ◽  
Celia E. Whitehouse ◽  
Jarle Mikalsen ◽  
Claire Hill ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Prosthetic Joint ◽  
Flow Test ◽  
Lateral Flow Test

AbstractBackgroundMicrobiological diagnosis of prosthetic joint infection (PJI) relies on culture techniques that are slow and insensitive. Rapid tests are urgently required to improve patient management. Calprotectin is a neutrophil biomarker of inflammation that has been demonstrated to be effective for the diagnosis of PJI. A calprotectin based lateral flow test has been developed for the rapid detection of PJI using synovial fluid samples.MethodsA convenience series of 69 synovial fluid samples from patients at the Norfolk and Norwich University Hospitals (NNUH) were collected intraoperatively from 52 hip and 17 knee revision operations. Calprotectin levels were measured using a new commercially available lateral flow assay for PJI diagnosis (Lyfstone). For all samples, synovial fluid was pipetted onto the lateral flow device and the signal was read using a mobile phone app after 15 minutes incubation at room temperature.ResultsAccording to the Musculoskeletal Infection Society (MSIS) criteria, 24 patients were defined as PJI positive and the remaining 45 were negative. The overall accuracy of the lateral flow test against the MSIS criteria was 75%. The test had a sensitivity and specificity of 75% and 76% respectively with a positive predictive value (PPV) of 62% and a negative predictive value (NPV) of 85%. Discordant results were then reviewed by the clinical team using available patient data to develop an alternative gold standard for defining presence/absence of infection (MSIS+). Compared to MSIS+, the test showed an overall accuracy of 83%, sensitivity and specificity of 95% and 78% respectively, a PPV of 62% and an NPV of 98%. Test accuracy for hip revisions was 77% and for knee revisions was 100%.ConclusionsThis study demonstrates that the calprotectin lateral flow assay is an effective diagnostic test for PJI. Our data suggests that the test is likely to generate false positive results in patients with metallosis and gross osteolysis.

scholarly journals The value of calprotectin in synovial fluid for the diagnosis of chronic prosthetic joint infection

2020 ◽  
Vol 9 (8) ◽  
pp. 450-456
Author(s):  
Zeyu Zhang ◽  
Yuanqing Cai ◽  
Guochang Bai ◽  
Chaofan Zhang ◽  
Wenbo Li ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
White Blood Cells ◽  
Area Under The Curve ◽  
Enzyme Linked Immunosorbent Assay ◽  
Polymorphonuclear Cells ◽  
Diagnostic Efficacy ◽  
Prosthetic Joint

Aims This study aimed to evaluate calprotectin in synovial fluid for diagnosing chronic prosthetic joint infection (PJI) . Methods A total of 63 patients who were suspected of PJI were enrolled. The synovial fluid calprotectin was tested by an enzyme-linked immunosorbent assay (ELISA). Laboratory test data, such as ESR, CRP, synovial fluid white blood cells (SF-WBCs), and synovial fluid polymorphonuclear cells (SF-PMNs), were documented. Chi-squared tests were used to compare the sensitivity and specificity of calprotectin and laboratory tests. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to determine diagnostic efficacy. Results The median calprotectin level was 776 μg/ml (interquartile range (IQR) 536.5 to 1132) in the PJI group and 54.5 μg/ml (IQR, 38.75 to 78.25) in the aseptic failure (AF) group (p < 0.05). Using a threshold of 173 ug/ml, the sensitivity was 95.2%, with a 97.6% specificity, and the AUC was 0.993. The sensitivity of calprotectin of the antibiotic-treated PJI group was 100% versus 90.9% of the non-antibiotic-treated PJI group. Although 47.6% (ten cases) of the patients in the PJI group received antibiotics before aspiration, the diagnostic efficacy of calprotectin was not affected. The sensitivity and specificity of ESR, CRP, SF-WBCs, and SF-PMNs ranged from 76.2% to 90.5% and 64.3% to 85.7%, respectively. Conclusion Calprotectin in synovial fluid has great diagnostic efficacy for PJI diagnosisand outperformed ESR, CRP, SF-WBCs, and SF-PMNs. Cite this article: Bone Joint Res 2020;9(8):450–456.

How Reliable Is the Cell Count Analysis in the Diagnosis of Prosthetic Joint Infection?

2018 ◽  
Vol 33 (10) ◽  
pp. 3257-3262 ◽  
Author(s):  
Akos Zahar ◽  
Christian Lausmann ◽  
Camila Cavalheiro ◽  
Anoop C. Dhamangaonkar ◽  
Tommaso Bonanzinga ◽  
...  
Keyword(s):  
Cell Count ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint
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