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  - Rüeckl, Kilian
A1  - Streck, Laura Elisa
A1  - Szewczykowski, Viktoria
A1  - Weißenberger, Manuel
A1  - Jakuscheit, Axel
A1  - Rudert, Maximilian
T1  - Diagnosis of chronic infection at total hip arthroplasty revision is a question of definition
JF  - Biomed Research International
N2  - Purpose. Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was evaluated for the different PJI definitions. Methods. 256 THA revisions were retrospectively classified to be infected or not infected. Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS). Only chronic PJIs were included. Results. PJI prevalence at revision significantly correlated with the applied PJI definition (p=0.01, Cramer's V=0.093). PJI prevalence was 20.7% for the MSIS, 25.4% for the ICM, 28.1% for the IDSA, and 32.0% for the EBJIS definition. For synovial fluid white blood cell count, the best ROC-AUC for predicting PJI was 0.953 in combination with the MSIS definition. Conclusion. PJI definition significantly influences the rate of diagnosed PJIs at THA revision. Synovial fluid white blood cell count is a reliable means to rule out PJI. In cases with a borderline high synovial white blood cell count before THA revision as the only sign of chronic PJI, an extended diagnostic work-up should be considered.
KW  - periprosthetic joint infection
KW  - algorithm
KW  - consensus
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265762
VL  - 2021
ER  -