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Leukocyte esterase from synovial fluid aspirate: a technical note.

Vinay K Aggarwal1, Eric Tischler, Elie Ghanem

  • 1Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.

The Journal of Arthroplasty
|August 8, 2012
PubMed
Summary

Diagnosing periprosthetic joint infections is challenging. Centrifugation enables accurate leukocyte esterase (LE) testing on bloody synovial fluid, improving diagnostic efficiency for orthopedic surgeons.

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Area of Science:

  • Orthopedics
  • Medical Diagnostics
  • Biochemistry

Background:

  • Periprosthetic joint infection (PJI) diagnosis is a significant clinical challenge.
  • Current diagnostic methods lack efficiency, speed, cost-effectiveness, and high sensitivity/specificity.
  • Bloody synovial fluid aspirates often interfere with standard diagnostic tests like colorimetric strip testing.

Purpose of the Study:

  • To develop and evaluate a simple, cost-effective protocol for leukocyte esterase (LE) testing in bloody synovial fluid from patients with suspected periprosthetic joint infections.
  • To determine if centrifugation affects the accuracy of LE testing in joint aspirates.

Main Methods:

  • A protocol using centrifugation was developed to process bloody synovial fluid aspirates.
  • Leukocyte esterase (LE) testing was performed on centrifuged samples.

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  • LE test results were analyzed for concordance in both septic and aseptic joint fluid samples.

    • Main Results:

    • The developed protocol allows for LE testing even with bloody joint aspirations.
    • A 100% concordance in LE enzyme test results was observed across all tested cases, regardless of septic or aseptic status.
    • Initial findings indicate that centrifugation does not negatively impact the accuracy of LE testing.

    Conclusions:

    • Centrifugation is a viable method to enable accurate leukocyte esterase (LE) testing on bloody synovial fluid aspirates.
    • This technique offers a promising approach to improve the efficiency and reliability of diagnosing periprosthetic joint infections.
    • Further validation studies are warranted to confirm these initial findings in a broader clinical context.