Evaluation for septic arthritis of the native adult knee is aided by multivariable assessment

Holzmeister, Adam M.; Frazzetta, Joseph; Yuan, Frank Feng Ning; Cherones, Arien; Summers, Hobie; Cohen, J.; Lack, William D.

doi:10.1016/j.ajem.2020.11.048

Cited by 7 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An association between septic arthritis and synovial WBC, synovial PMN%, and CRP has been well established; however, how these laboratory markers differ in patients with and without synovial crystals has not. 2,10,11 Holzmeister et al 7 reported that 21.7% (61/281) of aspirations had confirmed septic arthritis and the presence of synovial crystals reduced the odds of infection (OR 0.1, 95% CI, 0.1 to 0.4), which is similar to the findings of this study which found that 17.9% (54/302) of aspirations had confirmed septic arthritis with the infection rate being significantly lower in the presence of crystals (4.2% vs. 26.8%; P < 0.0001). This is intuitive because patients with synovial crystals are more likely to present with crystal arthropathy flares.…”

Section: Discussionmentioning

confidence: 99%

“…Given the similarities in presentations of septic arthritis and crystal arthropathy flares and diagnostic ambiguity between the two conditions, there is a need to better understand how the presentation of septic arthritis differs between patients with and without synovial fluid crystals. 6,7 The purpose of this study was to determine how the presence of synovial crystals affects the presentation of septic arthritis, specifically the CRP, synovial WBC, and synovial PMN% values that surgeons use to rule out infection.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Crystal Arthropathy on the Diagnostic Criteria of Native Septic Arthritis

Pesante,

Salimi,

Miller

et al. 2024

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Introduction: Distinguishing between septic arthritis and crystal arthropathy flares can be challenging. The purpose of this study was to determine how the presence of synovial crystals affects the diagnostic criteria of septic arthritis. Methods: A retrospective review identified patients undergoing joint aspirations to rule out native septic arthritis. Differences between septic arthritis presenting with and without synovial crystals were analyzed. A receiver-operating characteristic curve was plotted for laboratory markers to determine the area under the curve, or diagnostic accuracy, for septic arthritis and to evaluate thresholds that maximized sensitivity and specificity. Results: There were 302 joint aspirations in 267 patients. Septic arthritis was diagnosed in 17.9% (54/302). Patients with synovial crystals were less likely to have septic arthritis (4.2% [5/119] vs. 26.8% [49/183], P < 0.0001). Septic arthritis in patients with no synovial crystals was associated with fever and a higher synovial white blood cell (WBC) count, synovial polymorphonuclear cell percentage (PMN%), serum WBC, and C-reactive protein (CRP) (P < 0.05). Septic arthritis in patients with synovial crystals was only associated with inability to bear weight and a higher synovial WBC and CRP (P < 0.05). Synovial PMN% was considered nondiagnostic of septic arthritis (area under the curve 0.56) in patients with crystals while synovial WBC and CRP had acceptable (0.76) and excellent (0.83) diagnostic utility, respectively. The WBC and CRP value thresholds that maximized sensitivity and specificity for septic arthritis were greater in patients with crystals (21,600 vs. 17,954 cells/μL and 125 vs. 69 mg/L, respectively). Discussion: The presence of synovial crystals reduced the likelihood of septic arthritis and altered the laboratory diagnostic criteria. PMN% was nondiagnostic in the setting of synovial crystals.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Crystal Arthropathy on the Diagnostic Criteria of Native Septic Arthritis

Pesante,

Salimi,

Miller

et al. 2024

J Am Acad Orthop Surg

View full text Add to dashboard Cite

show abstract

“…In this study, intra‐operative findings and synovial fluid markers such as synovial WBC counts were not associated with the need for secondary surgery. Whilst there appears to be ample evidence advocating for the use of synovial white blood cell counts to diagnose septic arthritis [11, 13, 21], the role of synovial white blood cell counts to predict effectiveness of surgical debridement for septic arthritis is less established [29]. Stake et al [30] found that taken in isolation, the increased synovium WBC counts did not significantly predict patients who required secondary surgery for knee septic arthritis.…”

Section: Discussionmentioning

confidence: 99%

Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee

Yeo

Cuttilan

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeSeptic arthritis is an orthopaedic emergency with high morbidity and mortality. The aim of this study is to determine the risk factors associated with secondary surgery for septic arthritis of the native knee joint. MethodsThis is a retrospective study reviewing all patients who underwent surgery for septic arthritis of the knee from 2012 to 2019 in a single institution. A total of 117 patients were recruited. Patients were divided into 2 groups: Group I (79/117, 67.5%) underwent one surgery and Group II (38/117, 32.5%) underwent more than one surgery. ResultsPatients with a raised initial total white (TW) cell count of > 20 × 109/L had a significantly higher risk of secondary surgery. (Adjusted hazard ratio 2.42, p < 0.05) A decline of CRP level of less than 20% within 24 h from initial operation was also a risk for secondary surgery. (Adjusted hazard ratio 0.34, p < 0.01) Patients in group II also had significantly higher post‐operative median TW cell count and neutrophil count. There was no significant difference in the offending microbe, surgical approach, and duration of operation from initial presentation between the groups. ConclusionsPatients with septic arthritis of the native knee joint who present with raised initial total white cell count of > 20 × 109/L and decline of CRP level of less than 20% within 24 h from initial operation are at higher risk of secondary operation. In these patients, more aggressive treatment strategies and appropriate counselling on the risks of repeated surgery are recommended. Level of evidenceLevel IV.

show abstract

“…Infectious arthritis predisposes to severe joint damage, permanent disability, and mortality, with a mortality rate of 10%–15%. Data from Holzmeister et al [ 24 ] shows that the incidence of infectious arthritis has increased from 5.5/100 000 in 1998 to 7.8/100 000 in 2013, a 43% increase in incidence. Delayed or inappropriate treatment can lead to irreversible joint destruction or lesions.…”

Section: Introductionmentioning

confidence: 99%

Emerging advances in fluorescence imaging and phototherapy of arthritis

Wang,

Dai,

Shao

et al. 2023

Interdisciplinary Materials

View full text Add to dashboard Cite

Arthritis is a chronic disease whose etiology is difficult to pinpoint, and the difficulty of arthritis detection and subsequent treatment causes enormous distress to patients. In recent years, thanks to advances in medicine and detection, a variety of treatment modalities for arthritis have emerged. The combination of emerging detection technologies with different anti‐inflammatory medications and even advances in surgical techniques have all played a positive role in the treatment of arthritis. In the present work, we have collected relevant literature on fluorescence (FL) imaging and phototherapy of arthritis in recent years, intending to reveal the advantages and potential application value of FL imaging and phototherapy for researchers. Meanwhile, due to the shortcomings of FL imaging and phototherapy in the diagnosis and treatment of arthritis, we advocate overcoming these difficulties in future research.

show abstract

Evaluation for septic arthritis of the native adult knee is aided by multivariable assessment

Cited by 7 publications

References 20 publications

The Effect of Crystal Arthropathy on the Diagnostic Criteria of Native Septic Arthritis

The Effect of Crystal Arthropathy on the Diagnostic Criteria of Native Septic Arthritis

Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee

Emerging advances in fluorescence imaging and phototherapy of arthritis

Contact Info

Product

Resources

About