Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty
Aims: Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. The...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2021-08-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.28.BJO-2021-0109 |
| _version_ | 1819130447373795328 |
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| author | Michael Fuchs Felix Kirchhoff Heiko Reichel Carsten Perka Martin Faschingbauer Clemens Gwinner |
| author_facet | Michael Fuchs Felix Kirchhoff Heiko Reichel Carsten Perka Martin Faschingbauer Clemens Gwinner |
| author_sort | Michael Fuchs |
| collection | DOAJ |
| description | Aims: Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. Therefore, the aim of this study was to evaluate the variation of LC and PMN% in patients with aseptic revision total knee arthroplasty (TKA). Methods: We conducted a prospective, double-centre study of 40 patients with 40 knee joints. Patients underwent joint aspiration at two different time points with a maximum period of 120 days in between these interventions and without any events such as other joint aspirations or surgeries. The main indications for TKA revision surgery were aseptic implant loosening (n = 24) and joint instability (n = 11). Results: Overall, 80 synovial fluid samples of 40 patients were analyzed. The average time period between the joint aspirations was 50 days (SD 32). There was a significantly higher percentage change in LC when compared to PMN% (44.1% (SD 28.6%) vs 27.3% (SD 23.7%); p = 0.003). When applying standard definition criteria, LC counts were found to skip back and forth between the two time points with exceeding the thresholds in up to 20% of cases, which was significantly more compared to PMN% for the European Bone and Joint Infection Society (EBJIS) criteria (p = 0.001), as well as for Musculoskeletal Infection Society (MSIS) (p = 0.029). Conclusion: LC and PMN% are subject to considerable variation. According to its higher interindividual variance, LC evaluation might contribute to false-positive or false-negative results in PJI assessment. Single LC testing prior to TKA revision surgery seems to be insufficient to exclude PJI. On the basis of the obtained results, PMN% analyses overrule LC measurements with regard to a conclusive diagnostic algorithm. Cite this article: Bone Jt Open 2021;2(8):566–572. |
| first_indexed | 2024-12-22T08:59:45Z |
| format | Article |
| id | doaj.art-b2eea0d38b914145883a2fe0fdba1b0f |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-22T08:59:45Z |
| publishDate | 2021-08-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-b2eea0d38b914145883a2fe0fdba1b0f2022-12-21T18:31:45ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622021-08-012857658210.1302/2633-1462.28.BJO-2021-0109Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplastyMichael Fuchs0Felix Kirchhoff1Heiko Reichel2Carsten Perka3Martin Faschingbauer4Clemens Gwinner5RKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, GermanyRKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, GermanyRKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, GermanyDepartment of Orthopaedic Surgery, Charite Universitatsmedizin Berlin, Berlin, Berlin, GermanyRKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, GermanyDepartment of Orthopaedic Surgery, Charite Universitatsmedizin Berlin, Berlin, Berlin, GermanyAims: Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. Therefore, the aim of this study was to evaluate the variation of LC and PMN% in patients with aseptic revision total knee arthroplasty (TKA). Methods: We conducted a prospective, double-centre study of 40 patients with 40 knee joints. Patients underwent joint aspiration at two different time points with a maximum period of 120 days in between these interventions and without any events such as other joint aspirations or surgeries. The main indications for TKA revision surgery were aseptic implant loosening (n = 24) and joint instability (n = 11). Results: Overall, 80 synovial fluid samples of 40 patients were analyzed. The average time period between the joint aspirations was 50 days (SD 32). There was a significantly higher percentage change in LC when compared to PMN% (44.1% (SD 28.6%) vs 27.3% (SD 23.7%); p = 0.003). When applying standard definition criteria, LC counts were found to skip back and forth between the two time points with exceeding the thresholds in up to 20% of cases, which was significantly more compared to PMN% for the European Bone and Joint Infection Society (EBJIS) criteria (p = 0.001), as well as for Musculoskeletal Infection Society (MSIS) (p = 0.029). Conclusion: LC and PMN% are subject to considerable variation. According to its higher interindividual variance, LC evaluation might contribute to false-positive or false-negative results in PJI assessment. Single LC testing prior to TKA revision surgery seems to be insufficient to exclude PJI. On the basis of the obtained results, PMN% analyses overrule LC measurements with regard to a conclusive diagnostic algorithm. Cite this article: Bone Jt Open 2021;2(8):566–572.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.28.BJO-2021-0109periprosthetic joint infectiontotal knee arthroplastywhite blood cell countjoint aspirationsynovial analysissynovial fluidleucocytesaseptic revision total knee arthroplastyperiprosthetic joint infection (pji)joint aspirationsrevision surgeryjoint infectionknee jointsmusculoskeletal infectionimplant loosening |
| spellingShingle | Michael Fuchs Felix Kirchhoff Heiko Reichel Carsten Perka Martin Faschingbauer Clemens Gwinner Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty Bone & Joint Open periprosthetic joint infection total knee arthroplasty white blood cell count joint aspiration synovial analysis synovial fluid leucocytes aseptic revision total knee arthroplasty periprosthetic joint infection (pji) joint aspirations revision surgery joint infection knee joints musculoskeletal infection implant loosening |
| title | Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty |
| title_full | Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty |
| title_fullStr | Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty |
| title_full_unstemmed | Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty |
| title_short | Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty |
| title_sort | variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty |
| topic | periprosthetic joint infection total knee arthroplasty white blood cell count joint aspiration synovial analysis synovial fluid leucocytes aseptic revision total knee arthroplasty periprosthetic joint infection (pji) joint aspirations revision surgery joint infection knee joints musculoskeletal infection implant loosening |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.28.BJO-2021-0109 |
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