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Leukocyte Esterase Strip Test Can Predict Subsequent Failure Following Reimplantation in Patients With Periprosthetic
Michael M Kheir1, Colin T Ackerman1, Timothy L Tan1
1The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Background:
Leukocyte esterase (LE) strip test is an accurate marker for diagnosing periprosthetic joint infection (PJI). This study aims to determine if LE is a good predictor of persistent infection and/or subsequent failure in patients undergoing reimplantation.
Methods:
This single-institution study prospectively recruited and retrospectively analyzed 109 patients who underwent two-stage exchange treatment of PJI, from 2009-2016, and had an LE test performed at time of reimplantation. LE results of "2+" were considered positive. Ninety-five patients had 90-day minimum follow-up to assess treatment failure, defined by Delphi criteria. Eighteen patients were excluded due to blood contamination of LE test, resulting in a final cohort of 77 patients (mean follow-up 1.76 years).
Results:
Of the final cohort, 19 patients (24.7%) experienced subsequent failure. At reimplantation, LE test was positive in 22.2% of culture-positive and 4.4% of culture-negative cases. The LE test was negative in all patients who had not failed at latest follow-up, yielding sensitivity, specificity, positive predictive value, negative predictive value, and AUC of 26.3%, 100%, 100%, 87.5%, and 0.632, respectively; in comparison, MSIS criteria respectively yielded 25.0%, 87.3%, 27.6%, 85.8%, and 0.562 (P = .01 for specificity). Kaplan-Meier curves revealed higher failure rate in patients who had a positive LE test at time of reimplantation (P < .001).
Conclusion:
There is a dire need for an accurate diagnostic test to determine optimal timing of reimplantation in patients undergoing surgical treatment for PJI. The current study suggests that a positive LE test may be indicative of persistence of infection and results in a higher rate of subsequent failure.
Insights
The leukocyte esterase (LE) strip test can predict persistent periprosthetic joint infection (PJI) after reimplantation surgery. A positive LE test indicates a higher risk of subsequent treatment failure in PJI patients.
Area of Science:
- Orthopedics
- Infectious Diseases
- Diagnostic Medicine
Background:
- Periprosthetic joint infection (PJI) poses a significant challenge in orthopedic surgery.
- Accurate diagnostic tools are crucial for timely and effective PJI management.
- The leukocyte esterase (LE) strip test is a potential marker for diagnosing PJI.
Purpose of the Study:
- To evaluate the efficacy of the LE strip test in predicting persistent infection and subsequent failure in patients undergoing reimplantation for PJI.
- To compare the diagnostic performance of the LE test with established Musculoskeletal Infection Society (MSIS) criteria.
Main Methods:
- A prospective and retrospective analysis of 77 patients undergoing two-stage exchange for PJI.
- LE testing performed at the time of reimplantation, with "2+" considered positive.
- Follow-up assessed treatment failure using Delphi criteria, with a minimum of 90 days.
Main Results:
- A positive LE test at reimplantation was associated with a significantly higher rate of subsequent failure (P < .001).
- The LE test demonstrated high specificity (100%) and negative predictive value (87.5%) for detecting persistent infection.
- Compared to MSIS criteria, the LE test showed superior specificity (P = .01).
Conclusions:
- A positive LE strip test during reimplantation may indicate persistent PJI.
- The LE test is a valuable tool for predicting subsequent treatment failure in PJI patients.
- Further research is warranted to optimize the use of LE testing in PJI management.
