Complications - InfectionLeukocyte Esterase Strip Test Can Predict Subsequent Failure Following Reimplantation in Patients With Periprosthetic Joint Infection
Section snippets
Materials and Methods
This is a single-institution retrospective study of 109 prospectively collected patients who had undergone a prior resection arthroplasty and antibiotic-impregnated cement spacer, for treatment of chronic PJI, between January 2009 and January 2016, in whom an LE test was performed at the time of intended reimplantation. Of these, 96 patients had reimplantation while 13 patients received a spacer exchange. Diagnosis of PJI was made using the MSIS criteria [21]. During reimplantation, the status
Results
The rate of subsequent failure following reimplantation or the need for a spacer exchange at intended reimplantation in the overall cohort was 25.3% (24/95), and 24.7% in the final cohort (19/77). Thirteen patients had persistence of infection or reinfection as determined by at least one positive culture at the time of reimplantation; the LE test was positive in 2 of the 9 culture-positive cases at reimplantation (4 cases were excluded due to bloody aspiration) and in 3 of the 68
Discussion
PJI remains a major issue for our patients undergoing total joint arthroplasty 1, 2, 24, 25. The diagnosis of PJI is made using a combination of serological and synovial tests. As the preferred treatment for chronic PJI remains to be the 2-stage exchange arthroplasty, at least in North America, there is a dire need for a test or group of tests that can determine successful control of infection in patients who have undergone prior resection arthroplasty, and help determine the optimal timing of
Conclusion
This study provides encouraging data to support the use of the LE test in patients who have undergone prior resection arthroplasty and cement spacer insertion. The LE test is a simple, quick, and inexpensive test that appears to have utility for predicting the persistence of infection and a subsequent failure in patients undergoing reimplantation. Based on the findings of this study, we routinely utilize the LE test in patients undergoing reimplantation and allow the result of the test to guide
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Source of Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.01.031.