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Not all diagnostic tests can help exclude or diagnose infection in TKA

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AMSTERDAM — Among the many tests and imaging orthopaedic surgeons can order, only a few tests do an effective job to rule out infections in patients after total knee arthroplasty, according to a speaker here at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) Congress.

“There is just not a 100% safety check that will tell you this patient is not infected,” Wolfgang Klauser, MD, of Hamburg, said.

During an ESSKA-European Knee Associates combined symposium, he focused his comments on the diagnosis of infected TKA rather than on the prevention of infection. He discussed assessing how the knee looks by either viewing it during examination or radiographically as a good place to start the diagnostic process.

 

Wolfgang Klauser

Klauser stressed the importance of having a good history of the patient, including a recent history that may include any signs of bacteremia in the last few weeks or anything else that could signal an infection. He said it is also important to review the patient’s comorbidities.

“They seem to play a more and more important role in how to diagnose infections, how to treat infections, as well,” he said.

Furthermore, there are key radiologic signs will help orthopaedic surgeons make the right diagnosis, according to Klauser, and polymerase chain reaction (PCR) is not a recommended diagnostic test. That recommendation came from the results of The International Consensus Group on Periprosthetic Joint Infection meeting held last year, he said.

“[PCR] does not provide reliable and evidence-based results. That is so far. That might change in the future,” he said.

“The most important diagnostic tools are the C-reactive proteins, synovial white blood cell count and differential, culture aspiration and imaging, along with a clinical picture and the history of the patient. Of course, those always go along. A combination of those results will diagnose the infection and then always think it is infected unless proven otherwise,” Klauser said. – by Susan M. Rapp

Reference:

Klauser W. Session #SY43-8025. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 14-17, 2014. Amsterdam.

Disclosure: Klauser is a consultant to Zimmer.