Prosthetic Joint Infection Diagnosis

Studies of Intrasurgical Frozen-Section Histopathologic Findings of Acute Inflammation in Prosthetic Joint Infection Diagnosis

January 2010

The most useful pre-operative diagnostic test (where there is uncertainty) is joint aspiration for total and differential cell count and culture. Aspiration should not be performed through overlying cellulitis.  A synovial fluid leukocyte count of more than 1.7x103/μl or a neutrophil percentage of more than 65% is consistent with prosthetic knee infection.  Hip aspiration may require imaging guidance.  A synovial fluid leukocyte count of more than 4.2x103/μl or a neutrophil percentage of more than 80% is consistent with prosthetic hip infection.  These cutoffs are dramatically lower than those used to diagnose native joint infection.   Synovial fluid culture has a sensitivity ranging of 56 to 75% and specificity of 95 to 100%, and to achieve ideal sensitivity and specificity should be performed by inoculation into a blood culture bottle.  If an organism of questionable clinical significance is isolated, repeat synovial fluid aspiration for culture should be considered.  Prior antimicrobial therapy reduces sensitivity.

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Intrasurgical Frozen-Section Findings

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Jump to section:

• Introduction
• Total Hip and Knee Replacement Procedures United States 1990-2006
• Body Diagram
• Prosthetic Hip and Knee Infections United States 1990-2004
• Surgical Management of Prosthetic Hip or Knee Infection
• Common Causes Hip and Knee Arthroplasty Infection
• Unusual Causes of Prosthetic Joint Infection³
• Diagram
• Criteria for Diagnosis of Prosthetic Joint Infection
• Prosthetic Joint Infection Clinical Presentation
• C-Reactive Protein Erythrocyte Sedimentation Rate
• C-Reactive Protein Erythrocyte Sedimentation Rate
• Images
• ¹⁸F-fluoro-2-deoxyglucose Positron Emission Tomography/Computed Tomography Increased Activity Around the Bone-Prosthesis Interface
• Synovial Fluid Leukocyte/Differential Prosthetic Knee
• Studies of Intrasurgical Frozen-Section Histopathologic Findings of Acute Inflammation in Prosthetic Joint Infection Diagnosis
• Prospective Vortexing/Sonication Clinical Study Hip or Knee Implants⁶
• Staphylococcus epidermidis Biofilm on Polycarbonate Coupons Scanning Electron Microscopy
• Periprosthetic Tissue and Sonicate Fluid Culture
• Prospective Vortexing/Sonication Clinical Study Hip or Knee Implants⁶
• Definition of Prosthetic Hip and Knee Infection
• Number of Microorganisms Detected by Sonicate Fluid Culture
• Results Prosthetic Hip or Knee Infection
• Effect of Preoperative Antimicrobial Therapy on Culture Sensitivity in Patients with Prosthetic Hip or Knee Infection
• Diagram
• Prospective Clinical Study Shoulder Implants
• Prospective Clinical Study Shoulder Implants
• Definition of Definite Prosthetic Shoulder Infection
• Prospective Clinical Study Shoulder Implants
• Shoulder Arthroplasty Infection
• Acknowledgments
• References
• Questions?
• Disclosure