TY  - JOUR
A1  - Streck, Laura Elisa
A1  - Gaal, Chiara
A1  - Forster, Johannes
A1  - Konrads, Christian
A1  - Hertzberg-Boelch, Sebastian Philipp von
A1  - Rueckl, Kilian
T1  - Defining a synovial fluid white blood cell count threshold to predict periprosthetic infection after shoulder arthroplasty
JF  - Journal of Clinical Medicine
N2  - Background: The diagnosis of periprosthetic shoulder infection (PSI) requires a thorough diagnostic workup. Synovial fluid aspiration has been proven to be a reliable tool in the diagnosis of joint infections of the lower extremity, but shoulder specific data is limited. This study defines a threshold for synovial fluid white blood cell count (WBC) and assesses the reliability of microbiological cultures. Methods: Retrospective study of preoperative and intraoperative fluid aspiration of 31 patients who underwent a revision of a shoulder arthroplasty (15 with PSI defined by IDSA criteria, 16 without infection). The threshold for WBC was calculated by ROC/AUC analysis. Results: WBC was significantly higher in patients with PSI than in other patients. A threshold of 2800 leucocytes/mm\(^3\) showed a sensitivity of 87% and a specificity of 88% (AUROC 0.92). Microbiological cultures showed a sensitivity of 76% and a specificity of 100%. Conclusions: A threshold of 2800 leucocytes/mm\(^3\) in synovial fluid can be recommended to predict PSI. Microbiological culture has an excellent specificity and allows for targeted antibiotic therapy. Joint aspiration presents an important pillar to diagnose PSI.
KW  - upper extremity
KW  - joint infection
KW  - joint aspiration
KW  - leucocyte count
KW  - cutibacteria
KW  - ICM
KW  - MSIS
KW  - IDSA
KW  - WBC
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252275
SN  - 2077-0383
VL  - 11
IS  - 1
ER  - 
TY  - JOUR
A1  - Boelch, Sebastian Philipp
A1  - Weissenberger, Manuel
A1  - Spohn, Frederik
A1  - Rudert, Maximilian
A1  - Luedemann, Martin
T1  - Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers
JF  - Journal of Orthopedic Surgery and Research
N2  - Background:
Evaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated.

Methods:
Ninety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed.

Results:
The sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671).

Conclusions:
Synovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.
KW  - two-stage exchange
KW  - hip
KW  - periprosthetic infection
KW  - joint aspiration
KW  - spacer
Y1  - 2018
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175576
VL  - 13
IS  - 7
ER  -