Related Experiment Video
Updated: Mar 22, 2026
10:35
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
11.7K
Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection
Eric H Tischler1, Darren R Plummer2, Antonia F Chen1
1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
The Journal of Arthroplasty
|April 21, 2016
Summary
The leukocyte esterase (LE) strip test reliably rules out periprosthetic joint infection in patients undergoing total hip arthroplasty (THA) revision for adverse local tissue reactions (ALTRs). This diagnostic tool aids in differentiating infection from ALTRs.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Infectious Disease Diagnostics
Background:
- Adverse local tissue reactions (ALTRs) and periprosthetic joint infection (PJI) are complications following metal-on-metal total hip arthroplasty (THA).
- Both ALTRs and PJI can present with similar symptoms, including purulent synovial fluid and elevated white blood cell counts, complicating diagnosis.
- Distinguishing between ALTRs and PJI is crucial for appropriate patient management and treatment strategies.
Purpose of the Study:
- To evaluate the reliability of the leukocyte esterase (LE) strip test in ruling out periprosthetic joint infection (PJI) in patients undergoing revision surgery for adverse local tissue reactions (ALTRs) after total hip arthroplasty (THA).
Main Methods:
- Sixty-one patients undergoing THA revision for ALTRs were included in the study.
- Synovial fluid (SF) samples were analyzed using the LE strip test, with results categorized as negative/trace, positive (+), or strongly positive (++).
- Cases with metallic debris in SF were excluded from analysis.
Main Results:
- The LE strip test results were negative/trace in 63.9% of patients, mildly positive (+) in 23.0%, and strongly positive (++) in 13.1%.
- Mean SF white cell count was 1291.4 cells/μL (range: 0-10,886), with a mean polymorphonuclear percentage of 46.1% (range: 0%-94%).
- A strongly positive (++) LE strip test result, combined with preoperative assessments, demonstrated high accuracy in excluding infection.
Conclusions:
- The leukocyte esterase (LE) strip test is a valuable tool for ruling out periprosthetic joint infection (PJI) in the context of adverse local tissue reactions (ALTRs) after total hip arthroplasty (THA) revision.
- A strongly positive (++) LE strip test result, when used with preoperative work-ups, reliably excludes infection in 92.9% of patients undergoing THA revision for ALTRs.
- This diagnostic approach can help differentiate between ALTRs and PJI, guiding clinical decision-making.
