Synovial fluid differential cell count in wear debris synovitis after total knee replacement

Schwarzkopf, Ran; Carlson, Evan M.; Tibbo, Meagan E.; Josephs, Lee; Scott, Richard D.

doi:10.1016/j.knee.2014.07.014

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…We evaluated all hips in light of the recommendations of the 2018 ICM (WBC count of 3000 cells/mL and PMN% of 70%) [15] to see what proportion of them would have been characterized as likely having PJI on basis of those cutoff values. Our primary study outcome was WBC count assessment, and our secondary outcome was the PMN%.…”

Section: Primary and Secondary Study Outcomesmentioning

confidence: 99%

What Is the Impact of Automated Synovial Cell Counting on Different Aseptic Causes and Periprosthetic Conditions Associated With Revision THA?

Abdelaziz

Aljawabra

Roßmann

et al. 2021

Clin Orthop Relat Res

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Background Studies have suggested that automated synovial cell counting may overestimate the white blood cell (WBC) count, resulting in false positive tests when evaluating patients for the possibility of periprosthetic joint infection (PJI) after THA. However, associations between WBC counts high enough to mimic PJI in patients whose arthroplasties are not infected but rather are experiencing a variety of aseptic problems-including but not limited to metallosis, polyethylene wear, and recurrent dislocation-have not, to our knowledge, been adequately addressed. In addition, there is a lack of analyses about the polymorphonuclear percentage (PMN%) when assessed by automated analyzers in this context. Questions/purposes In the context of different indications for aseptic revision and different periprosthetic hip pathologic findings, we asked: (1) What were the synovial WBC count levels, and what proportion of values were above the 2018 International Consensus Meeting (ICM) cutoff (3000 cells/ mL)? (2) What were the synovial PMN% levels, and what proportion of values were above the 2018 ICM (70%)? Methods We retrospectively studied the preoperative cell count analyses of synovial fluid in patients who underwent revision THA for aseptic reasons at our tertiary referral arthroplasty center between January 2015 and December 2017. We considered all revisions performed on patients during that time potentially eligible, and after prespecified exclusions were applied (exclusions mainly included 15% [197 of 1306] sporadic missing data and 12% [155 of 1306] insufficient synovial fluid obtained in the aspirate), a total of 702 patients undergoing revision THA for aseptic reasons remained for the final analysis. As far as we know, no patients underwent re-revision for PJI at a mean follow-up of 46 6 11 months, which tends to confirm our impression that indeed these hips did not have PJI. Cell count analyses were conducted using an automated analyzer. Clinical findings, preoperative radiographs, and surgical reports-confirmed by available histologic results--were used to establish diagnoses. We evaluated these hips considering the recommendations of the 2018 ICM (WBC count of One of the authors (MC) certifies receipt of personal payments or benefits, during the study period, in an amount of less than USD 10,000 from W. Link & Co KG, outside the submitted manuscript. One of the authors (TG) certifies receipt of personal payments or benefits, during the study period, in an amount of USD 10,000 to USD 100,000 from W. Link & Co KG, in an amount of USD 10,000 to USD 100,000 from Zimmer Biomet Inc, and in an amount of USD 10,000 to USD 100,000 from CeramTec Co, all outside the submitted manuscript. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was obtained from the Ethik-Komission der Arztekammer Hamburg, Hamburg, Germany (WF-115120).

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Section: Primary and Secondary Study Outcomesmentioning

confidence: 99%

What Is the Impact of Automated Synovial Cell Counting on Different Aseptic Causes and Periprosthetic Conditions Associated With Revision THA?

Abdelaziz

Aljawabra

Roßmann

et al. 2021

Clin Orthop Relat Res

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“… 6 It is commonly treated by antibiotic treatment combined with open wound debridement as illustrated in many literature. 7 , 8 , 9 , 10 However, the success rate is in general less than 60%, 11 a relatively low percentage. Peersman et al.…”

Section: Discussionmentioning

confidence: 99%

The infection of Mycoplasma hominis after total knee replacement: Case report and literature review

Hongjiu

et al. 2017

Chinese Journal of Traumatology

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The Mycoplasma hominis infection is a rare postoperative complication after joint replacement. Based on our knowledge, there were only two cases reported by Korea all over the world currently. A case of postoperative Mycoplasma hominis infection after total knee replacement in our hospital was reported in this article. It was confirmed through mass spectrometer and Mycoplasma cultivation and treated by the first stage debridement, polyethylene insert replacement, and then drainage and irrigation combined with sensitive antibiotics after the operation. We observed that the C reactive protein (CRP) level correlates with the development of disease, while the erythrocyte sedimentation rate (ESR) remains at a high level, indicating the relevance between the Mycoplasma hominis infection caused by knee joint replacement and CRP. This study aims to report the case and review relevant literature.

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“…In the aseptic group, slight differences may occur between aseptic loosening and PE wear. This is likely because of particle debris, although we did not identify any in our cohort [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

Bäcker

Krüger³

et al. 2020

JCM

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Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.

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Synovial fluid differential cell count in wear debris synovitis after total knee replacement

Cited by 10 publications

References 22 publications

What Is the Impact of Automated Synovial Cell Counting on Different Aseptic Causes and Periprosthetic Conditions Associated With Revision THA?

What Is the Impact of Automated Synovial Cell Counting on Different Aseptic Causes and Periprosthetic Conditions Associated With Revision THA?

The infection of Mycoplasma hominis after total knee replacement: Case report and literature review

Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

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