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Updated: Jul 8, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Is large unstained cell percentage (%LUC) a novel diagnostic marker for periprosthetic joint infections?
Serhat Akçaalan1, Batuhan Akbulut1, Ceyhun Çağlar2
1Orthopedics and Traumatology Department, Ankara City Hospital, Ankara, Turkey.
Backround:
Periprosthetic joint infection (PJI) is a very important complication that occurs after total joint replacement. Diagnosing PJI is at least as difficult as this disease. There is no biomarker that alone can diagnose PJI.
Objective:
This study aimed to evaluate the effectiveness of large unstained cell percentage (%LUC) in diagnosing PJI and deciding on re-implantation in two stage septic exchange arthroplasty.
Methods:
Patients who underwent revision arthroplasty between 2019 and 2023 were screened retrospectively. These patients were grouped as those who underwent two-stage septic exchange and those who underwent aseptic exchange. Prosthesis removal from the patients who underwent two-stage septic exchange, before spacer application, and on the 3rd post-operative day after spacer application, Blood parameters were collected at the 1st month and before the second stage after the spacer application, and before the revision surgery from the patients who underwent aseptic exchange. White blood cell, neutrophil percentage, %LUC, albumin, sedim and CRP values were checked and recorded one by one from all patients.
Results:
The data of a total of 233 patients, including 133 patients in the two stage septic exchange group and 100 patients in the aseptic exchange group, were included in the study. When the predictive value of %LUC in PJI was accepted as cut-off 1.75, the sensitivity was 69.2% and the specificity was 73%. The change in %LUC over time in patients who underwent two-stage septic exchange was statistically significant (p= 0.0001). A positive correlation was found between the value of .%LUC after spacer application and the value of CRP before prosthesis protrusion/spacer application surgery, and the Spearman correlation coefficient was found to be 0.005.
Conclusion:
%LUC value can be a promising biomarker for the diagnosis of PJI by considering both sensitivity and specificity rates. Apart from this, it is an easily accessible and effective biomarker for re-implantation decision making and evaluation of response to treatment, especially in two-stage septic exchange surgeries.
Insights
Large unstained cell percentage (%LUC) shows promise as a biomarker for diagnosing periprosthetic joint infection (PJI). This easily accessible marker aids in re-implantation decisions and treatment evaluation, particularly in two-stage septic exchange surgeries.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomarker Discovery
Background:
- Periprosthetic joint infection (PJI) is a significant complication following total joint replacement.
- Accurate diagnosis of PJI remains challenging due to the lack of a single definitive biomarker.
Purpose of the Study:
- To evaluate the diagnostic effectiveness of large unstained cell percentage (%LUC) for PJI.
- To assess %LUC's utility in guiding re-implantation decisions in two-stage septic exchange arthroplasty.
Main Methods:
- Retrospective analysis of 233 patients undergoing revision arthroplasty (2019-2023).
- Patients were categorized into two-stage septic exchange and aseptic exchange groups.
- Blood parameters, including %LUC, WBC, neutrophil percentage, albumin, ESR, and CRP, were analyzed at various time points.
Main Results:
- With a %LUC cut-off of 1.75, sensitivity was 69.2% and specificity was 73% for PJI diagnosis.
- A statistically significant change in %LUC over time was observed in the two-stage septic exchange group (p=0.0001).
- A positive correlation was found between post-spacer %LUC and pre-revision CRP levels (Spearman's rho=0.005).
Conclusions:
- %LUC demonstrates potential as a valuable biomarker for PJI diagnosis, offering acceptable sensitivity and specificity.
- %LUC is an accessible and effective tool for re-implantation decisions and treatment response assessment in two-stage septic exchange surgeries.
