Synovial fluid absolute neutrophil count may be able to detect PJI
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Key takeaways:
- Synovial fluid absolute neutrophil count had a sensitivity of 88.4% for detecting periprosthetic joint infection.
- It also had a greater area under the curve vs. white cell count and polymorphonuclear percentage.
Synovial fluid absolute neutrophil count may be superior in detecting periprosthetic joint infection compared with synovial fluid white blood cell count and synovial fluid polymorphonuclear percentage, according to results presented here.
“We think this holds a lot of promise, and our small study had better performance for diagnosing prosthetic joint infection compared to the traditional synovial fluid markers of the synovial fluid white cell count and the [polymorphonuclear] PMN percentage,” Kenneth B. Mathis, MD, an associate professor in the department of orthopedic surgery at McGovern Medical School at UTHealth Houston, said in his presentation at the Musculoskeletal Infection Society Annual Meeting.
Mathis and colleagues retrospectively reviewed synovial fluid white cell count, synovial fluid PMN percentage and synovial fluid absolute neutrophil count from 231 patients undergoing revision surgery between 2020 and 2022. Patients were categorized into groups based on whether they underwent either aseptic revision (n = 136) or septic revision (n = 95). Using the 2018 Musculoskeletal Infection Society definition for PJI, Mathis said researchers calculated sensitivity, specificity, the positive likelihood ratio, the negative likelihood ratio and the diagnostic odds ratio.
“We used Youden’s J statistic to come up with an absolute neutrophil count of 1,950 cells per microliter,” he said.
According to Mathis, synovial fluid absolute neutrophil count had a sensitivity of 88.4%, a specificity of 85.2%, a positive likelihood ratio of 6, a negative likelihood ratio of 0.1 and a diagnostic odds ratio of 44.2.
The receiver operating characteristic curve showed the synovial fluid absolute neutrophil count had, “a greater area under the curve than the PMN percentage and the white cell count,” Mathis said.
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Shahi A, et al. Paper 1346. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 2-3, 2024; Durham, North Carolina (hybrid).
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