经初次膝关节置换术后翻修的患者中，用于诊断假体周围关节感染的检测试验的表现。
The Performance of Diagnostic Tests for Identifying Periprosthetic Joint Infection After Failed Partial Knee Arthroplasty.
机构信息
Department of Orthopaedic Surgery, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Orthopaedic Surgery, University Hospitals/Cleveland Medical Center, Cleveland, Ohio.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
J Arthroplasty. 2022 Dec;37(12):2449-2454. doi: 10.1016/j.arth.2022.06.021. Epub 2022 Jun 30.
BACKGROUND
Indications for unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty are expanding. Despite the lower published infection rates for UKA and patello-femoral arthroplasty than total knee arthroplasty, periprosthetic joint infection (PJI) remains a devastating complication and diagnostic thresholds for commonly utilized tests have not been investigated recently. Thus, this study evaluated if diagnostic thresholds for PJI in patients who had a failed partial knee arthroplasty (PKA) align more closely with previously reported thresholds specific to UKA or the 2018 International Consensus Meeting on Musculoskeletal Infection.
METHODS
We identified 109 knees in 100 patients that underwent PKA with eventual conversion to total knee arthroplasty within a single healthcare system from 2000 to 2021. Synovial fluid nucleated cell count and synovial polymorphonuclear percentage in addition to preoperative serum erythrocyte sedimentation rate, serum C-reactive protein, and serum white blood cell count were compared with Student's t-tests between septic and aseptic cases. Receiver operating characteristic curves and Youden's index were used to assess diagnostic performance and the optimal cutoff point of each test.
RESULTS
Synovial nucleated cell count, synovial polymorphonuclear percentage, and serum C-reactive protein demonstrated excellent discrimination for diagnosing PJI with an area under the curve of 0.97 and lower cutoff values than the previously determined UKA specific criteria. Serum erythrocyte sedimentation rateESR demonstrated good ability with an area under the curve of 0.89.
CONCLUSION
Serum and synovial fluid diagnostic thresholds for PJI in PKAs align more closely with the thresholds established by the 2018 International Consensus Meeting as compared to previously proposed thresholds specific to UKA.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
背景
单髁膝关节置换术（UKA）和髌股关节置换术的适应证正在扩大。尽管 UKA 和髌股关节置换术的感染率低于全膝关节置换术，但假体周围关节感染（PJI）仍然是一种破坏性的并发症，并且最近尚未研究常用检测方法的诊断阈值。因此，本研究评估了在接受部分膝关节置换术（PKA）失败后患者中，PJI 的诊断阈值是否更接近先前报道的 UKA 特异性或 2018 年肌肉骨骼感染国际共识会议特异性阈值。
方法
我们在单一医疗系统中确定了 2000 年至 2021 年间 100 名患者中的 109 例接受 PKA 且最终转为全膝关节置换术的患者。通过 Student's t 检验比较了关节液有核细胞计数和关节液多形核细胞百分比以及术前血清红细胞沉降率、血清 C 反应蛋白和血清白细胞计数在感染和非感染病例之间的差异。使用受试者工作特征曲线和 Youden 指数评估了每种检测方法的诊断性能和最佳截断值。
结果
关节液有核细胞计数、关节液多形核细胞百分比和血清 C 反应蛋白对诊断 PJI 的鉴别能力很强，曲线下面积为 0.97，且低于先前确定的 UKA 特异性标准的截断值。血清红细胞沉降率 ESR 具有良好的能力，曲线下面积为 0.89。
结论
与 UKA 特异性阈值相比，PKA 中 PJI 的血清和关节液诊断阈值更接近 2018 年国际共识会议确定的阈值。
证据等级
三级，回顾性比较研究。
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