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Excluding infections in arthroplasty using leucocyte esterase test

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Abstract

Purpose

Periprosthetic joint infections remain a major challenge for the surgeon in modern arthroplasty. The decision on how to handle a case is often difficult due to the variety of clinical presentations. The aim of this study was to establish the leucocyte esterase test as an intra-operative rapid diagnostic tool in an unclear infected or aseptic situation.

Methods

In the setting of 364 endoprosthetic joint procedures on knee, hip and shoulder, we aspirated synovial fluid before performing capsulotomy. We performed a leucocyte esterase test. The results were correlated with the pre-operative synovial fluid aspirations, the laboratory blood sample parameters (C-reactive protein, white blood cells) and the intra-operative histopathological and microbiological findings.

Results

The leucocyte esterase test has a sensitivity of 100 % and a specificity of 96.5 %. The positive predictive value was 82 % and the negative predictive value was 100 %. Correlation with conventional methods such as serum C-reactive protein and serum white blood cells is given. The histopathological evaluation confirmed the microbiological results in all but three cases.

Conclusions

Based on our results and the current literature, we recommend the leucocyte esterase test as a useful tool in the diagnosis of periprosthetic joint infection.

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Acknowledgments

This study was supported by HELIOS Kliniken GmbH, grant ID 004145. Major parts of this contribution are components of the thesis of Thomas Kokenge.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Orthopaedic Department, HELIOS Endo-Klinik Hamburg, Holstenstraße 9, 22767, Hamburg, Germany

    Daniel Guenther, Thomas Kokenge, Oliver Jacobs, Thorsten Gehrke, Daniel Kendoff & Carl Haasper

  2. Trauma Department, Hanover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hanover, Germany

    Daniel Guenther, Mohamed Omar & Christian Krettek

Authors
  1. Daniel Guenther
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  2. Thomas Kokenge
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  3. Oliver Jacobs
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  7. Daniel Kendoff
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  8. Carl Haasper
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Correspondence to Daniel Guenther.

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Guenther, D., Kokenge, T., Jacobs, O. et al. Excluding infections in arthroplasty using leucocyte esterase test. International Orthopaedics (SICOT) 38, 2385–2390 (2014). https://doi.org/10.1007/s00264-014-2449-0

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  • DOI: https://doi.org/10.1007/s00264-014-2449-0

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