Stefanie Donner, Georg Matziolis, Yves Gramlich, Igor Lazic, Daniel Schrednitzki, Anne Pohrt, Nora Renz, Nils Meißner
{"title":"较低的滑膜白细胞计数和多形核百分比可靠地区分单室膝关节置换术后假体周围关节感染。","authors":"Stefanie Donner, Georg Matziolis, Yves Gramlich, Igor Lazic, Daniel Schrednitzki, Anne Pohrt, Nora Renz, Nils Meißner","doi":"10.1002/ksa.70036","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine diagnostic thresholds for synovial fluid leucocyte count and polymorphonuclear (PMN) percentage to identify the diagnosis periprosthetic joint infection (PJI) in patients with failed unicompartmental knee arthroplasties (UKAs).</p><p><strong>Methods: </strong>This multicentre retrospective cohort study included 239 patients who underwent revision of an UKA for either septic or aseptic indications at five university-affiliated medical centres. Among these, 30 patients (13%) underwent revision for PJI and 209 (87%) for noninfectious causes. PJI was diagnosed according to the European Bone and Joint Infection Society (EBJIS) criteria. Preoperative synovial fluid leucocyte count, synovial PMN percentage, serum C-reactive protein (CRP) and white blood cell (WBC) count were evaluated. Diagnostic performance and optimal thresholds for each parameter were assessed using receiver operating characteristic curves and Youden's index.</p><p><strong>Results: </strong>The PJI group demonstrated significantly higher median synovial leucocyte counts (11,399/μL vs. 429/μL, p < 0.001), and significantly higher synovial PMN percentage (82% vs. 28%, p < 0.001) compared to the non-PJI group. The optimal diagnostic cut-off for synovial fluid leucocyte count was 2318/μL (area under curve [AUC] 0.93; sensitivity 83%, specificity 95%) and for PMN percentage, 64% (AUC 0.90; sensitivity 76%, specificity 95%). Serum CRP (cut-off 9 mg/L; AUC 0.85) and WBC count (cut-off 8 G/L; AUC 0.71), showed lower diagnostic accuracy.</p><p><strong>Conclusions: </strong>This study establishes UKA-specific diagnostic thresholds for PJI, which are consistent with the EBJIS PJI criteria established for TKA. Synovial biomarkers, particularly synovial fluid leucocyte count and PMN percentage, demonstrated superior diagnostic performance compared to serum CRP and WBC count. These findings underscore the need for tailored diagnostic criteria to improve the accuracy of PJI diagnosis and guide clinical decision-making in UKA revision.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0000,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lower synovial leucocyte count and polymorphonuclear percentage reliably differentiate periprosthetic joint infection after unicompartmental knee arthroplasty.\",\"authors\":\"Stefanie Donner, Georg Matziolis, Yves Gramlich, Igor Lazic, Daniel Schrednitzki, Anne Pohrt, Nora Renz, Nils Meißner\",\"doi\":\"10.1002/ksa.70036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study aimed to determine diagnostic thresholds for synovial fluid leucocyte count and polymorphonuclear (PMN) percentage to identify the diagnosis periprosthetic joint infection (PJI) in patients with failed unicompartmental knee arthroplasties (UKAs).</p><p><strong>Methods: </strong>This multicentre retrospective cohort study included 239 patients who underwent revision of an UKA for either septic or aseptic indications at five university-affiliated medical centres. Among these, 30 patients (13%) underwent revision for PJI and 209 (87%) for noninfectious causes. PJI was diagnosed according to the European Bone and Joint Infection Society (EBJIS) criteria. Preoperative synovial fluid leucocyte count, synovial PMN percentage, serum C-reactive protein (CRP) and white blood cell (WBC) count were evaluated. Diagnostic performance and optimal thresholds for each parameter were assessed using receiver operating characteristic curves and Youden's index.</p><p><strong>Results: </strong>The PJI group demonstrated significantly higher median synovial leucocyte counts (11,399/μL vs. 429/μL, p < 0.001), and significantly higher synovial PMN percentage (82% vs. 28%, p < 0.001) compared to the non-PJI group. The optimal diagnostic cut-off for synovial fluid leucocyte count was 2318/μL (area under curve [AUC] 0.93; sensitivity 83%, specificity 95%) and for PMN percentage, 64% (AUC 0.90; sensitivity 76%, specificity 95%). Serum CRP (cut-off 9 mg/L; AUC 0.85) and WBC count (cut-off 8 G/L; AUC 0.71), showed lower diagnostic accuracy.</p><p><strong>Conclusions: </strong>This study establishes UKA-specific diagnostic thresholds for PJI, which are consistent with the EBJIS PJI criteria established for TKA. Synovial biomarkers, particularly synovial fluid leucocyte count and PMN percentage, demonstrated superior diagnostic performance compared to serum CRP and WBC count. 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引用次数: 0
摘要
目的：本研究旨在确定滑膜液白细胞计数和多形核（PMN）百分比的诊断阈值，以确定单室膝关节置换术（UKAs）失败患者假体周围关节感染（PJI）的诊断。方法：这项多中心回顾性队列研究包括239名患者，他们在5所大学附属医疗中心接受了脓毒症或无菌适应症的UKA修订。其中，30例（13%）患者接受了PJI翻修，209例（87%）患者接受了非感染性原因翻修。PJI是根据欧洲骨关节感染协会（EBJIS）的标准诊断的。术前评估滑膜液白细胞计数、滑膜PMN百分比、血清c反应蛋白（CRP）和白细胞（WBC）计数。采用受试者工作特征曲线和约登指数对各参数的诊断性能和最佳阈值进行评估。结果：PJI组滑膜白细胞中位数明显高于对照组（11,399/μL vs. 429/μL）。结论：本研究建立了PJI的uka特异性诊断阈值，与EBJIS为TKA建立的PJI标准一致。与血清CRP和WBC计数相比，滑膜生物标志物，特别是滑膜液白细胞计数和PMN百分比显示出更优越的诊断性能。这些发现强调了定制诊断标准的必要性，以提高PJI诊断的准确性，并指导临床决策在UKA修订。证据等级：三级。
Lower synovial leucocyte count and polymorphonuclear percentage reliably differentiate periprosthetic joint infection after unicompartmental knee arthroplasty.
Purpose: This study aimed to determine diagnostic thresholds for synovial fluid leucocyte count and polymorphonuclear (PMN) percentage to identify the diagnosis periprosthetic joint infection (PJI) in patients with failed unicompartmental knee arthroplasties (UKAs).
Methods: This multicentre retrospective cohort study included 239 patients who underwent revision of an UKA for either septic or aseptic indications at five university-affiliated medical centres. Among these, 30 patients (13%) underwent revision for PJI and 209 (87%) for noninfectious causes. PJI was diagnosed according to the European Bone and Joint Infection Society (EBJIS) criteria. Preoperative synovial fluid leucocyte count, synovial PMN percentage, serum C-reactive protein (CRP) and white blood cell (WBC) count were evaluated. Diagnostic performance and optimal thresholds for each parameter were assessed using receiver operating characteristic curves and Youden's index.
Results: The PJI group demonstrated significantly higher median synovial leucocyte counts (11,399/μL vs. 429/μL, p < 0.001), and significantly higher synovial PMN percentage (82% vs. 28%, p < 0.001) compared to the non-PJI group. The optimal diagnostic cut-off for synovial fluid leucocyte count was 2318/μL (area under curve [AUC] 0.93; sensitivity 83%, specificity 95%) and for PMN percentage, 64% (AUC 0.90; sensitivity 76%, specificity 95%). Serum CRP (cut-off 9 mg/L; AUC 0.85) and WBC count (cut-off 8 G/L; AUC 0.71), showed lower diagnostic accuracy.
Conclusions: This study establishes UKA-specific diagnostic thresholds for PJI, which are consistent with the EBJIS PJI criteria established for TKA. Synovial biomarkers, particularly synovial fluid leucocyte count and PMN percentage, demonstrated superior diagnostic performance compared to serum CRP and WBC count. These findings underscore the need for tailored diagnostic criteria to improve the accuracy of PJI diagnosis and guide clinical decision-making in UKA revision.
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