%0 Journal Article
%T Are All Joints Equal? Synovial Fluid Analysis in Periprosthetic Joint Infection
%A Andreas M. M¨¹ller
%A Elie Berbari
%A Parham Sendi
%J Journal of Bone and Joint Infection
%D 2018
%R 10.7150/jbji.30491
%X Neutrophils play a key role when recruited into circulation and to sites of infection or inflammation. Synovial fluid Gram-staining and microbiological studies have been implemented for the diagnostic work-up of both native and prosthetic joint infections (PJIs) for many decades. Joint synovial fluid cell count and differential analysis has been traditionally used to elucidate the underlying cause of acute native arthritis. Leukocyte count and differential were introduced in the diagnostic workup of PJI between 1998 and 2004. Over the past 20 years, several studies assessed the diagnostic accuracy of leukocyte count and differential from synovial fluid in patients with suspected PJI [1-10]. These studies identified the optimal cut-off value for PJI diagnosis to be approximately more than one log lower than for native joint septic arthritis. In earlier studies, these lower values produced unit errors in the transition from native to prosthetic joints infection [11]. Leukocytes/¦̀L or leukocytes/ 10-3cm3 are the currently recommend units for synovial cell count analyses. In parallel to these studies, laboratory institutions switched from manual to automated cell counting [12, 13], and cell count cut-off values were extrapolated to arthroplasties other than hip and knee joints [14]. For simplicity, providers tend to use one single optimal cut-off value irrespective of anatomic location of the prosthetic joint.
%U http://www.jbji.net/v03p0258.htm