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Periprosthetic joint infection diagnosis: a complete understanding of white blood cell count and differential

Benjamin Zmistowski1, Camilo Restrepo, Ronald Huang

  • 1The Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

The Journal of Arthroplasty
|May 1, 2012
PubMed

Insights

Serum white blood cell count (WBC) has limited utility in diagnosing periprosthetic joint infection (PJI). Synovial fluid analysis remains crucial for accurate PJI diagnosis in failed arthroplasty patients.

Area of Science:

  • Orthopedics
  • Infectious Disease
  • Medical Diagnostics

Background:

  • Serum white blood cell (WBC) count utility for periprosthetic joint infection (PJI) diagnosis is increasingly questioned.
  • Synovial fluid WBC and neutrophil (PMN) percentage are established accurate markers for PJI.

Purpose of the Study:

  • To investigate the correlation between serum and synovial fluid WBC levels.
  • To evaluate the diagnostic value of serum and synovial fluid WBC parameters in patients with failed arthroplasty.

Main Methods:

  • Retrospective analysis of 153 patients undergoing revision knee arthroplasty (73 with PJI).
  • Comparison of serum and synovial fluid WBC, PMN count, and lymphocyte count.
  • Assessment of diagnostic accuracy for PJI using receiver operating characteristic (ROC) analysis.

Main Results:

  • Weak correlations observed between joint fluid and serum for WBC (R=0.19), PMN count (R=0.31), and lymphocyte count (R=-0.22).
  • Synovial WBC (93%) and PMN% (95%) showed high diagnostic accuracy for PJI.
  • Serum WBC analysis did not significantly improve PJI diagnostic accuracy.

Conclusions:

  • Serum WBC count offers minimal added value for diagnosing PJI in revision arthroplasty.
  • Synovial fluid analysis, particularly WBC and PMN percentage, remains the gold standard for PJI diagnosis.

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