Ten patients were classified as confirmed infections according to the EBJIS definition (7 THA and 5 TKA). Statistic quality criteria were calculated and compared using a binary classification test. Synovial white blood cell count (WBC), percentage of polymorphonuclear neutrophils (PMC), serum C-reactive protein (CRP) and synovial calprotectin using a lateral-flow-assay were tested against the European Bone and Joint Infection Society (EBJIS) definition for PJI. The extent of osteolysis was classified according to Engh et al., Paprosky et al., and the modern Knee Society Radiographic Evaluation and Scoring System. Thirty-three patients were included in this prospective study between February of 2019 and November of 2021. The purpose of this study was to evaluate calprotectin for the diagnosis of PJI in cases that preoperatively demonstrate moderate to severe periprosthetic osteolysis or implant migration as signs for implant loosening in THA and TKA. Concerns have already been raised in cases with metallosis and severe periprosthetic osteolysis because wear-induced inflammation may yield false positive results. However, its diagnostic utility has not been evaluated explicitly in cases with marked loosening or migration of the implant. This is called a culture.Synovial calprotectin has been demonstrated as a promising biomarker for periprosthetic joint infections (PJI) in painful total hip (THA) and knee arthroplasties (TKA). Joint fluid added to a substance that promotes the growth of germs (such as bacteria or a fungus) may show an infection. Gram stain and culture.īacteria in the joint fluid that are causing an infection may be seen under a microscope after being coloured with a Gram stain (a special dye). Calcium pyrophosphate crystals mean you have pseudogout. Uric acid crystals in the joint mean you have gout. Large numbers of white blood cells may be caused by gout, pseudogout, other types of arthritis (such as rheumatoid arthritis), psoriatic arthritis, injury, or infection. Large numbers of red blood cells may be caused by bleeding in the joint from injury, inflammation, or abnormal clotting of the blood. Milky white may be caused by infection or inflammation or a condition such as gout. A deep, dark red colour may be caused by bleeding in the joint. Slightly cloudy fluid may be caused by inflammation, gout, or pseudogout. No bacteria are seen, and no organisms grow in the culture.īacteria are seen, or organisms grow in the culture. Large numbers of red or white blood cellsĬrystals (seen under a special microscope with polarized light) No large numbers of red or white blood cells The results from a culture usually take a few days. The results of a joint fluid analysis are usually ready the same day. An elastic bandage may also be wrapped around your joint, such as your knee, to reduce swelling. It can help keep fluid from building up again.Ī tight (pressure) bandage will be placed over the site to reduce swelling and bruising. A cortisone shot may be given into the joint before the needle is removed. Samples of the fluid may be put in special tubes or containers and sent to the lab. A syringe attached to the needle is used to remove a sample of joint fluid. For young children, a sedative may also be given.Ī long, thin needle is slowly inserted in the joint area. A local anesthetic is often injected into the skin over the joint. The skin over the joint area will be cleaned with antiseptic solution. Your doctor may use ultrasound to guide the needle placement. Your doctor will examine the joint to find out where the needle should be inserted. You will sit or lie down on an examining table. Depending on which joint will be examined, you may be asked to undress and put on a hospital gown. Joint fluid analysis can be done in your doctor's office, clinic, operating room, or emergency room.
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