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Prosthetic Joint Infection Diagnosis



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

Slide 16

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.

Intrasurgical Frozen-Section Findings

 


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