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Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection

BACKGROUND: Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid aci...

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Autores principales: Theil, Christoph, Ackmann, Thomas, Gosheger, Georg, Puetzler, Jan, Moellenbeck, Burkhard, Schwarze, Jan, Schulze, Martin, Klingebiel, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675884/
https://www.ncbi.nlm.nih.gov/pubmed/36402933
http://dx.doi.org/10.1186/s10195-022-00672-5
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author Theil, Christoph
Ackmann, Thomas
Gosheger, Georg
Puetzler, Jan
Moellenbeck, Burkhard
Schwarze, Jan
Schulze, Martin
Klingebiel, Sebastian
author_facet Theil, Christoph
Ackmann, Thomas
Gosheger, Georg
Puetzler, Jan
Moellenbeck, Burkhard
Schwarze, Jan
Schulze, Martin
Klingebiel, Sebastian
author_sort Theil, Christoph
collection PubMed
description BACKGROUND: Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study’s purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI. MATERIALS AND METHODS: 92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; n = 25) or knee (TKA, n = 67) were prospectively investigated. In our cohort 33% (30/92) had PJI and 67% (62/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden’s index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off > 3000 leukocytes) and percentage of neutrophils (PMN%, cut-off > 80%). RESULTS: The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; p < 0.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively. CONCLUSION: Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed. LEVEL OF EVIDENCE: 2a, diagnostic study. Trial registration German Clinical Trials Register (Registration number: DRKS00021038).
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spelling pubmed-96758842022-11-21 Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection Theil, Christoph Ackmann, Thomas Gosheger, Georg Puetzler, Jan Moellenbeck, Burkhard Schwarze, Jan Schulze, Martin Klingebiel, Sebastian J Orthop Traumatol Original Article BACKGROUND: Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study’s purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI. MATERIALS AND METHODS: 92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; n = 25) or knee (TKA, n = 67) were prospectively investigated. In our cohort 33% (30/92) had PJI and 67% (62/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden’s index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off > 3000 leukocytes) and percentage of neutrophils (PMN%, cut-off > 80%). RESULTS: The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; p < 0.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively. CONCLUSION: Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed. LEVEL OF EVIDENCE: 2a, diagnostic study. Trial registration German Clinical Trials Register (Registration number: DRKS00021038). Springer International Publishing 2022-11-19 2022-12 /pmc/articles/PMC9675884/ /pubmed/36402933 http://dx.doi.org/10.1186/s10195-022-00672-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Theil, Christoph
Ackmann, Thomas
Gosheger, Georg
Puetzler, Jan
Moellenbeck, Burkhard
Schwarze, Jan
Schulze, Martin
Klingebiel, Sebastian
Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
title Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
title_full Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
title_fullStr Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
title_full_unstemmed Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
title_short Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
title_sort synovial fluid ph is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675884/
https://www.ncbi.nlm.nih.gov/pubmed/36402933
http://dx.doi.org/10.1186/s10195-022-00672-5
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