Diagnosing Infection in the Setting of Periprosthetic Fractures

November 20, 2016 at 12:48 pm

Journal of Arthroplasty September 2016 V.31 N.9 P.140–143

Roshan P. Shah, Darren R. Plummer, Mario Moric, Scott M. Sporer, Brett R. Levine, Craig J. Della Valle

Background

The diagnosis of periprosthetic joint infection is particularly challenging in patients with periprosthetic fractures. The purpose of this study was to investigate the utility of commonly used diagnostic tests for periprosthetic joint infection in patients with a periprosthetic fracture.

Methods

Of 121 patients treated with a periprosthetic fracture (97 hips, 24 knees, mean age: 72.9), 14 (11.6%) met Musculoskeletal Infection Society criteria for infection. Diagnostic variables were evaluated using logistic regression models for the prediction of infection and receiver operating characteristics curves.

Results

The synovial white blood cell (WBC) count and differential were the best diagnostic tests, with good test performance (area under the curve, 84%) and optimal cutoffs of 2707 WBC/uL and 77% polymorphonuclear cells. The erythrocyte sedimentation rate and C-reactive protein were found to have overall lower test performance but remained relatively sensitive at standard cutoff values of 30 mm/h and 10 mg/L, respectively.

Conclusion

The synovial fluid WBC count and differential are the best tests with optimal cutoff values that are similar to those used for patients without a periprosthetic fracture.

abstract

http://www.arthroplastyjournal.org/article/S0883-5403(16)00287-4/fulltext

 

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)00287-4/pdf

Entry filed under: Antimicrobianos, Bacterias, Biología Molecular, Epidemiología, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones en piel y tej blandos, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Metodos diagnosticos, Resistencia bacteriana, Update. Tags: .

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