Polymorphonuclear Cell Count on Frozen Section Is Not an Absolute Index of Reimplantation in Infected Total Knee Arthroplasty

Cho, Woo-Shin; Byun, Seoung-Eun; Cho, Won-Joon; YOON, Yoo-Seok; Dhurve, Kunal

doi:10.1016/j.arth.2013.03.016

Cited by 14 publications

(5 citation statements)

References 14 publications

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“…In this study, 5 cases of persistent infection were defined by the histopathologic tissue samples at ROS, while cultures remained sterile. However, a small study by Cho et al could not demonstrate the impact of fresh frozen sections on the outcome after ROS [ 19 ]. Other means, such as the leucocyte esterase test or the alpha-defensin immunoassay, have not been investigated at the second stage of the two-stage exchange [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Boelch¹,

Weißenberger²,

Spohn³

et al. 2018

J Orthop Surg Res

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BackgroundEvaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated.MethodsNinety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed.ResultsThe sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671).ConclusionsSynovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.

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Section: Discussionmentioning

confidence: 99%

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Boelch¹,

Weißenberger²,

Spohn³

et al. 2018

J Orthop Surg Res

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show abstract

“…Numerous attempts have been made to determine the eradication of infection before reimplantation. However, prior studies have suggested limited predictive values of the widely used biomarkers for diagnosis of PJI, including serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) [8, 9], synovial white blood cell (WBC) count and percentage of polymorphonuclear cells (PMN%) [7], aspiration culture [10], and histology analysis [11, 12]. Additionally, aspiration performed on hips with the antibiotic spacer can be hard with a high risk of “dry tap” despite the aid of fluoroscopic guidance [7, 13].…”

Section: Introductionmentioning

confidence: 99%

Plasma fibrinogen may predict persistent infection before reimplantation in two-stage exchange arthroplasty for periprosthetic hip infection

Xu¹,

Qu²,

Chai³

et al. 2019

J Orthop Surg Res

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Background The diagnosis of persistent infection before reimplantation in two-stage exchange arthroplasty for periprosthetic joint infection (PJI) remains challenging. Currently, several studies suggested coagulation-related markers, such as D-dimer and fibrinogen, may be promising in diagnose of PJI. The purpose of the study was to investigate the predictive values of plasma D-dimer and fibrinogen for assessment of persistent infection before reimplantation hip arthroplasty. Methods We retrospectively reviewed 129 hips that treated with two-stage exchange arthroplasty for PJI from 2012 to 2016 in our institution. The persistent infection before reimplantation was based on a modified Musculoskeletal Infection Society (MSIS) criteria. After exclusion, 102 hips were included in the final analysis. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of plasma D-dimer and fibrinogen in predicting persistent infection before reimplantation. Results The area the under ROC curves (AUC) for fibrinogen (0.773; 95% confidential interval [CI], 0.569–0.905) was significantly higher than that of D-dimer (0.565; 95% CI, 0.329–0.777). With the calculated threshold of fibrinogen set at 3.61 g/L, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5%, 62.8%, 16.7%, and 98.3%, respectively. With the threshold value of D-dimer set at 0.82 μg/mL, the sensitivity, specificity, PPV, and NPV was 83.3%, 41.9%, 21.7%, and 92.9%, respectively. Conclusions In conclusion, the current study reveals that the plasma fibrinogen may be a promising biomarker in predicting persistent infection before reimplantation. Further prospective studies with larger cohorts are needed to validate predictive values and optimal thresholds of coagulation-related markers.

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“…However, in a series of 15 patients, Cho et. al [ 46 ] reported that the presence of 5 to 20 PMNs per HPF at the moment of reimplantation was not associated with re-infection (n = 0/15) at a minimum follow-up of two years. Moreover, George et al [ 47 ] using a threshold of five PMNs per HPF in at least three HPFs, demonstrated that histopathology was 94% (95% CI, 89–99%) specific yet only 50% (95%CI, 13–88%) sensitive in detecting a persistent infection at reimplantation.…”

Section: Spacer Exchangementioning

confidence: 99%

Is There a Role for Spacer Exchange in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection?

Kozaily

Chisari

Parvızı

2020

JCM

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Periprosthetic joint infection (PJI) continues to be one of the most serious complications after hip and knee arthroplasty. The choice of surgical treatment depends on a multitude of factors like chronicity of infection, host factors, and institutional or surgeon experience. Two-stage exchange remains one of the most commonly used technique for chronic PJI in the United States of America. The intended two-stage revision may involve an additional interim procedure where the initial antibiotic cement spacer is removed and a new spacer is inserted. Mostly, the rationale behind spacer exchange is an additional load of local antibiotics before proceeding to reimplantation. There is no conclusive evidence whether a spacer exchange confers additional benefits, yet it delays reimplantation and exposes already fragile patients to the risks and morbidity of an additional surgery.

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Polymorphonuclear Cell Count on Frozen Section Is Not an Absolute Index of Reimplantation in Infected Total Knee Arthroplasty

Cited by 14 publications

References 14 publications

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Plasma fibrinogen may predict persistent infection before reimplantation in two-stage exchange arthroplasty for periprosthetic hip infection

Is There a Role for Spacer Exchange in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection?

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