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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Preoperative testing for sepsis before revision total knee arthroplasty
Craig J Della Valle1, Scott M Sporer, Joshua J Jacobs
1Department of Orthopaedic Surgery, Rush Uiversity Medical Center, Chicago, Illinois 60612, USA.
The Journal of Arthroplasty
|October 11, 2007
Summary
Diagnosing knee arthroplasty infections requires careful testing. A synovial fluid white blood cell (WBC) count over 3000 is highly accurate, while erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are good initial screening tools.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnostics
- Biomarker Analysis
Background:
- Periprosthetic joint infections (PJIs) are a significant complication following knee arthroplasty.
- Accurate and timely diagnosis of infection is crucial for effective treatment and patient outcomes.
- Various diagnostic modalities exist, but their individual and combined efficacy requires clear definition.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a comprehensive perioperative testing protocol for detecting infection in painful knee arthroplasties.
- To identify the most precise diagnostic test for periprosthetic joint infection (PJI) in this patient cohort.
- To establish a rational approach for perioperative sepsis evaluation in knee arthroplasty patients.
Main Methods:
- A uniform diagnostic protocol was applied to 105 consecutive painful knee arthroplasty patients.
- Tests included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial fluid white blood cell (WBC) count and differential, intraoperative frozen section, and culture.
- Data were analyzed to determine the sensitivity, specificity, and accuracy of each test and the overall protocol.
Main Results:
- Synovial fluid WBC count >3000 demonstrated high diagnostic precision (100% sensitivity, 98% specificity, 99% accuracy).
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) served as effective screening tools, with only one infection missed when both were normal.
- The comprehensive protocol effectively identified infected knee arthroplasties.
Conclusions:
- A synovial fluid WBC count exceeding 3000 is the most accurate indicator for diagnosing knee arthroplasty infection.
- Preoperative ESR and CRP levels are valuable for initial screening of potential infections.
- A tiered approach combining screening tests (ESR, CRP) with more definitive tests (synovial fluid WBC, frozen section) is recommended for perioperative sepsis evaluation.
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