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Updated: Apr 27, 2026

Knee Arthrocentesis in Adults
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Excluding infections in arthroplasty using leucocyte esterase test.

Daniel Guenther1, Thomas Kokenge, Oliver Jacobs

  • 1Orthopaedic Department, HELIOS Endo-Klinik Hamburg, Holstenstraße 9, 22767, Hamburg, Germany, guenther.daniel@mh-hannover.de.

International Orthopaedics
|July 17, 2014
PubMed
Summary

The leucocyte esterase test accurately diagnoses periprosthetic joint infections. This rapid intra-operative tool offers high sensitivity and specificity, aiding surgeons in unclear cases.

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Periprosthetic joint infections (PJIs) pose a significant challenge in modern arthroplasty.
  • Clinical presentations of PJIs are diverse, complicating diagnostic decisions.
  • Effective intra-operative diagnostic tools are crucial for managing suspected infections.

Purpose of the Study:

  • To evaluate the leucocyte esterase test as a rapid intra-operative diagnostic tool.
  • To assess its utility in differentiating infected from aseptic joint conditions.
  • To establish its role in managing unclear cases during arthroplasty.

Main Methods:

  • Synovial fluid was aspirated from 364 knee, hip, and shoulder endoprosthetic procedures prior to capsulotomy.
  • A leucocyte esterase test was performed on the aspirated synovial fluid.

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  • Results were correlated with pre-operative aspirations, laboratory markers (CRP, WBC), and intra-operative histopathology and microbiology.

    • Main Results:

    • The leucocyte esterase test demonstrated 100% sensitivity and 96.5% specificity for PJI diagnosis.
    • Positive predictive value was 82%, and negative predictive value was 100%.
    • Findings correlated well with conventional diagnostic methods and intra-operative evaluations.

    Conclusions:

    • The leucocyte esterase test is a valuable tool for diagnosing periprosthetic joint infections.
    • Its high accuracy supports its use in intra-operative decision-making.
    • Recommended for use in unclear infected or aseptic situations during arthroplasty.