Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Yi, Paul H.; Cross, Michael B.; Moric, Mario; Levine, Brett R.; Sporer, Scott M.; Paprosky, Wayne G.; Jacobs, Joshua J.; Valle, Craig J. Della

doi:10.1007/s11999-014-3902-5

Cited by 80 publications

(47 citation statements)

References 31 publications

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“…Previous studies have examined the use of preoperative hip aspirations in helping to diagnose periprosthetic joint infections [1,3,25,30,33]. It has been suggested that preoperative aspirations should be performed on select patients with an intermediate to high risk of infection based on clinical and radiographic findings [1,3,14].…”

Section: Discussionmentioning

confidence: 99%

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

Newman

George

Klika

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Periprosthetic joint infection is a serious complication after THA and commonly is treated with a two-stage revision. Antibiotic-eluting cement spacers are placed for local delivery of antibiotics. Aspirations may be performed before the second-stage reimplantation for identification of persistent infection. However, limited data exist regarding the diagnostic parameters of synovial fluid aspiration with or without saline lavage from a hip with an antibiotic-loaded cement spacer. Questions/purposes We asked: (1) For hips with antibiotic cement spacers, does saline lavage influence the diagnostic validity of aspirations? (2) What is the diagnostic accuracy of preoperative aspirations performed on hips with antibiotic cement spacers using the Musculoskeletal Infection Society (MSIS) criteria, stratified by saline and nonlavage? (3) For hips with antibiotic spacers, what are the optimal thresholds for synovial fluid white blood cell (WBC) count and polymorphonuclear neutrophil (PMN) percentage for diagnosing infections? Methods One hundred seventy-four hips (155 patients) with antibiotic-eluting cement spacers inserted between October 2012 and July 2015 were reviewed. Of these, 98 hips (80 patients) met the inclusion criteria and were included in the analysis (77 nonlavage, 21 saline lavage aspirations). Laboratory data from the aspiration and preoperative workup and intraoperative details were collected. Infection status of each hip procedure was determined One of the authors certifies that he (WKB), or a member of his immediate family, has or may receive payments or benefits, during the study period an amount of USD 100,001 to USD 1,000,000 from Stryker (Kalamazoo, MI, USA); an amount of USD 100,001 to USD 1,000,000 from Exactech (Gainesville, FL, USA); an amount of less than USD 10,000 from Zimmer (Warsaw, IN, USA); an amount of less than USD 10,000 from Custom Orthopaedic Solutions (Cleveland, OH, USA; an amount of USD 100,001 to USD 1,000,000 from KEF Healthcare (Westminster, CO, USA); amount of less than USD 10,000 from iVHR (Cleveland, OH, USA); an amount of less than USD 10,000 from PeerWell (San Francisco, CA, USA), and has received research support from Zimmer (Warsaw, IN, USA), DJO (Vista, CA, USA), and Orthosensor (Dania Beach, FL, USA). One of the authors (CAH) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from KCI (San Antonio, TX, USA); an amount of less than USD 10,000 from Zimmer Biomet (Warsaw, IN, USA); an amount of less than USD 10,000 from Covance (Princeton, NJ, USA); an amount of less than USD 10,000 from Pfizer (New York, NY, USA); and has received research support funding from Stryker (Kalamazoo, MI, USA), Myoscience (Fresno, CA, USA), CD Diagnostics (Claymont, DE, USA), KCI (San Antonio, TX, USA), OREF (Rosemont, IL, USA), and Pacira (Parsippany, NJ, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are ...

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Section: Discussionmentioning

confidence: 99%

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

Newman

George

Klika

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…They reported a 75 % sensitivity and 67 % specificity in diagnosing PJI if both the CRP was >8.0 mg/L and ESR was >22 mm/h [23•]. There have been other case reports of failed MOM articulations masking as infection in the literature as well [32,34].…”

Section: Serum Inflammatory Markersmentioning

confidence: 99%

“…However, MOM articulations can falsely elevate both the white blood cell (WBC) count and neutrophil percentage. Metal particles, degenerating cells, and foreign debris can falsely elevate the WBC count [32]. One study showed that while automated WBC count of >3000 cells/uL was 100 % sensitive for diagnosing PJI, it was only 57 % specific [23•].…”

Section: Aspiration Of the Hip Jointmentioning

confidence: 99%

“…Therefore, multiple studies recommend obtaining a manual WBC count from the synovial fluid aspirate to alert the technician that the sample may be inaccurate due to confounding variables that may artificially raise the WBC count [23•, 32]. Once these inaccurate samples are excluded by a manual cell count, the sensitivity and specificity have been shown to be 100 and 94 %, respectively, if a WBC count of 4350 cells/uL was utilized [32].…”

Section: Aspiration Of the Hip Jointmentioning

confidence: 99%

“…One study showed that a neutrophil percentage of >80 % was 100 % sensitive and 97 % specific for infection [23•]. Another study reported an 82 % sensitivity and 87 % sensitivity in diagnosing PJI [32]. Another study showed that a predominance of monocytes is typical for an ALTR [16•].…”

Section: Aspiration Of the Hip Jointmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty

Chalmers

Perry

Taunton

et al. 2016

Curr Rev Musculoskelet Med

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The effect of the inflammatory species hypochlorous acid on the corrosion and surface damage of Ti‐6Al‐4V and CoCrMo alloys

Kubacki

Gilbert

2018

J Biomedical Materials Res

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Performance of metallic orthopedic alloys is dependent on the local biological conditions within the joint. Inflammation within a joint can lead to severe conditions at the surface of the implant and may represent a driving force of corrosion which is not well understood. In this study, the corrosion response of CoCrMo and Ti-6Al-4V alloys was studied in hypochlorous acid (HOCl) saline solutions, which served as a simulated inflammatory environment. Anodic polarization and electrochemical impedance spectroscopy were used to evaluate the electrochemical behavior of these alloys in a range of hypochlorous acid solutions. The open circuit potential of CoCrMo rose to over 600 mV (vs. Ag/AgCl) in 30 mM HOCl solutions while the corresponding corrosion current increased three orders of magnitude over controls. Visual analysis of CoCrMo disks after immersion in 50 mM HOCl for 5 days revealed extensive surface damage. This study shows that HOCl can polarize CoCrMo surfaces above the transpassive potential without an external power source. Ultimately, long-term exposure to HOCl within an inflamed joint may significantly affect patient outcomes through accelerated generation of corrosion products. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 3185-3194, 2018.

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Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Cited by 80 publications

References 31 publications

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty

The effect of the inflammatory species hypochlorous acid on the corrosion and surface damage of Ti‐6Al‐4V and CoCrMo alloys

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