Karlidag Taner, Zanna Luigi, Traverso Giacomo, Lee Min-Jae, Gehrke Thorsten, Citak Mustafa
Department of Orthopedics and Traumatology, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):25. doi: 10.1007/s00402-024-05652-4.
The diagnostic challenges of periprosthetic joint infection (PJI) for orthopedic surgeons are significant. Prior research has indicated that patients with adverse reactions, dislocations, and aseptic loosening exhibit a heightened count of white blood cells (WBC) in their synovial fluid, along with an increased polymorphonuclear cell percentage (PMN%). The prevalence of false-positive results raises concerns about the reliability of these tools in distinguishing aseptic failure from PJI.
We have performed a retrospective inquiry of the medical records of all patients who have undergone aseptic revision total knee arthroplasty (TKA) at our tertiary referral arthroplasty center. We conducted an assessment on 552 knees by applying the guidelines set forth by the 2018 International Consensus Meeting. Recorded preoperative parameters: aspiration results (WBC, PMN%, and AD immunoassay), preoperative and intraoperative diagnoses, microbiologic and histopathologic findings from periprosthetic tissue samples, and prosthetic details.
Among the causes of aseptic revision investigated, patients with polyethylene wear exhibited the highest median WBC count (median 1091 cells/µL, range 83.5-1715.5 cells/µL; p = 0.010). Concerning periprosthetic conditions, patients with wear-induced synovitis exhibited a significantly higher synovial fluid WBC count (median 1093 cells/µL, range 587-1683 cells/µL; p < 0.001). Among all the reasons for failure, periprosthetic fractures had the greatest percentage of WBC counts surpassing 3000 cells/µL (18.1% [2 of 11]; p = 0.006).
Our study has uncovered significant variations in WBC count during aseptic revision TKA when utilizing automated cell counting. Therefore, to optimize diagnostic accuracy in synovial aspiration during aseptic revision TKA, it is advisable to employ a combination of WBC count and PMN%, along with manual counting techniques or AD, depending on the specific clinical scenario.
III.
人工关节周围感染（PJI）给骨科医生带来了重大的诊断挑战。先前的研究表明，出现不良反应、脱位和无菌性松动的患者，其滑液中的白细胞（WBC）计数升高，同时多形核细胞百分比（PMN%）也增加。假阳性结果的发生率引发了人们对这些工具在区分无菌性失败和PJI方面可靠性的担忧。
我们对在我们的三级转诊关节置换中心接受无菌性翻修全膝关节置换术（TKA）的所有患者的病历进行了回顾性调查。我们根据2018年国际共识会议制定的指南对552个膝关节进行了评估。记录术前参数：抽吸结果（WBC、PMN%和AD免疫测定）、术前和术中诊断、假体周围组织样本的微生物学和组织病理学发现以及假体细节。
在调查的无菌性翻修原因中，聚乙烯磨损患者的WBC计数中位数最高（中位数为1091个细胞/微升，范围为83.5 - 1715.5个细胞/微升；p = 0.010）。关于假体周围情况，磨损性滑膜炎患者的滑液WBC计数显著更高（中位数为1093个细胞/微升，范围为587 - 1683个细胞/微升；p < 0.001）。在所有失败原因中，假体周围骨折的WBC计数超过3000个细胞/微升的百分比最高（18.1%[11例中的2例]；p = 0.006）。
我们的研究发现，在无菌性翻修TKA期间使用自动细胞计数时，WBC计数存在显著差异。因此，为了优化无菌性翻修TKA期间滑膜抽吸的诊断准确性，建议根据具体临床情况结合使用WBC计数和PMN%，以及手工计数技术或AD。
III级。
