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Leukocyte esterase strip test as a reliable intraoperative PJIs biomarker. Our experience
Paolo Di Benedetto1, Giovanni Dalla Vecchia, Federico Dante
1Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy. paolo.dibenedetto@asuiud.sanita.fvg.it.
Abstract:
ackgroud and aim of work: Prosthetic joint infection (PJI) is the most common cause of total knee replacement failure and the third most common cause of total hip replacement failure, accounting for 16.8% of all knee revisions and 14.8% of the hip revisions; nevertheless, the diagnosis of PJI is often a challenge for the orthopaedic surgeon. The aim of these study was to evaluate the reliability of the LE strip test for diagnosis of PJI.
Materials And Methods:
From December 2016 to January 2019, we enrolled 50 patients with suspected PJI; 32 females and 18 males, the average age at the time of the surgery was 76 years. Twenty-four patients underwent knee revision surgery and twenty-six hip revision surgery. In all patients during the surgery, the synovial fluid was aspirated and used for leukocyte esterase strip test. The result of the tests was compared to periprosthetic tissues culture, histological examination and sonication fluid culture for PJI.
Results:
Comparing the results obtained from the LE test with the results obtained from the other diagnostic methods, we found that the concordance between the results of the leukocyte-esterase test and those of the culture test with peri-prosthetic tissue or synovial fluid was shown to be 93%, between LE and histological examinations, the concordance was 93% and finally with the culture of the sonicated fluid the concordance was 86% of the cases.
Conclusions:
The results of our serie show a good intraoperative diagnostic accuracy of the LE test, especially in its ability to exclude the hypothesis of periprosthetic infection in case of a negative result.
Insights
The leukocyte esterase (LE) strip test shows high accuracy in diagnosing prosthetic joint infections (PJI), particularly in ruling out infection when results are negative. This rapid test aids orthopedic surgeons in managing PJI cases effectively.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Diagnostic Medicine
Background:
- Prosthetic joint infection (PJI) is a leading cause of total knee and hip replacement failure.
- Accurate and timely diagnosis of PJI remains a significant challenge for orthopedic surgeons.
- PJI accounts for a substantial percentage of revision surgeries, impacting patient outcomes and healthcare costs.
Purpose of the Study:
- To evaluate the diagnostic reliability of the leukocyte esterase (LE) strip test for identifying PJI.
- To compare the LE strip test's accuracy against established diagnostic methods for PJI.
- To assess the LE test's utility as an intraoperative tool for PJI diagnosis.
Main Methods:
- A prospective study involving 50 patients with suspected PJI undergoing revision surgery (knee and hip).
- Synovial fluid was aspirated intraoperatively for LE strip testing.
- LE test results were compared with periprosthetic tissue culture, histological examination, and sonication fluid culture.
Main Results:
- The LE strip test demonstrated high concordance with other diagnostic methods: 93% with peri-prosthetic tissue/synovial fluid culture, 93% with histological examination, and 86% with sonication fluid culture.
- The LE test showed good intraoperative diagnostic accuracy.
- A negative LE test result was particularly effective in excluding the possibility of periprosthetic infection.
Conclusions:
- The LE strip test is a reliable intraoperative diagnostic tool for PJI.
- The LE test offers high sensitivity and specificity, especially for ruling out infection.
- This rapid diagnostic method can assist surgeons in making timely clinical decisions regarding PJI management.
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