Utility of Serum Inflammatory and Synovial Fluid Counts in the Diagnosis of Infection in Taper Corrosion of Dual Taper Modular Stems

Young-Min Kwon, Valentin Antoci, William A Leone, Tsung-Yuan Tsai, Dimitris Dimitriou, Ming Han Lincoln Liow
Journal of Arthroplasty 2016, 31 (9): 1997-2003

BACKGROUND: An accurate diagnosis of periprosthetic joint infection (PJI) is critical as treatment of the infected total hip arthroplasty differs from aseptic failure. The clinical presentation of PJI may mimic symptoms of taper corrosion. Our aim was to evaluate the utility of serum inflammatory markers and synovial fluid white blood cell (WBC)/differential counts in diagnosis of PJI in failed dual taper total hip arthroplasty due to taper corrosion.

METHODS: We retrospectively reviewed 62 dual taper modular stem patients who underwent revision surgery for symptomatic adverse local tissue reaction due to taper corrosion. All patients had preoperative hip synovial aspirations, serum inflammatory markers, metal ion levels, and intraoperative cultures. Using Musculoskeletal Infection Society PJI criteria, we divided the cohort into infected and noninfected groups. Receiver-operating characteristic curves were constructed to determine the relationship and optimal cutoff values for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and synovial fluid counts.

RESULTS: Infection group had significantly higher mean ESR (P = .002), CRP (P = .01), synovial fluid WBC (P < .001), and neutrophil percentage (P = .02). Cobalt levels were significantly elevated in noninfection group (P = .02). Using receiver-operating characteristic curve analysis, the most ideal tests for diagnosis of PJI were synovial fluid WBC (area under the curve = 86%, optimal cutoff 730 WBC/uL) and neutrophil percentage (area under the curve = 83%, optimal cutoff 65%). ESR and CRP thresholds of 22 mm/h and 3 mg/L demonstrated 57% sensitivity and 95% specificity and 29% sensitivity and 93% specificity for detection of PJI, respectively.

CONCLUSION: Our study suggests that ESR and CRP are useful in excluding PJI in dual taper modular implants with corrosion, whereas both synovial WBC count and neutrophil percentage are useful markers for diagnosing infection.

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