Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection.
Periprosthetic joint infection
Revision hip arthroplasty
Revision knee arthroplasty
Synovial fluid
Journal
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
ISSN: 1590-9999
Titre abrégé: J Orthop Traumatol
Pays: Italy
ID NLM: 101090931
Informations de publication
Date de publication:
19 Nov 2022
19 Nov 2022
Historique:
received:
05
08
2022
accepted:
30
10
2022
entrez:
19
11
2022
pubmed:
20
11
2022
medline:
23
11
2022
Statut:
epublish
Résumé
Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study's purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI. 92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; n = 25) or knee (TKA, n = 67) were prospectively investigated. In our cohort 33% (30/92) had PJI and 67% (62/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden's index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off > 3000 leukocytes) and percentage of neutrophils (PMN%, cut-off > 80%). The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; p < 0.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively. Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed. 2a, diagnostic study. Trial registration German Clinical Trials Register (Registration number: DRKS00021038).
Sections du résumé
BACKGROUND
BACKGROUND
Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study's purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI.
MATERIALS AND METHODS
METHODS
92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; n = 25) or knee (TKA, n = 67) were prospectively investigated. In our cohort 33% (30/92) had PJI and 67% (62/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden's index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off > 3000 leukocytes) and percentage of neutrophils (PMN%, cut-off > 80%).
RESULTS
RESULTS
The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; p < 0.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively.
CONCLUSION
CONCLUSIONS
Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed.
LEVEL OF EVIDENCE
METHODS
2a, diagnostic study. Trial registration German Clinical Trials Register (Registration number: DRKS00021038).
Identifiants
pubmed: 36402933
doi: 10.1186/s10195-022-00672-5
pii: 10.1186/s10195-022-00672-5
pmc: PMC9675884
doi:
Banques de données
DRKS
['DRKS00021038']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
52Subventions
Organisme : Westfälische Wilhelms-Universität Münster
ID : Open Access Funds
Informations de copyright
© 2022. The Author(s).
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