Discussion:
- WBC
- C-reactive protein and ERS :
- references:
- Use of ESR and C-Reactive Protein Level to Diagnose Infection Before Revision Total Knee Arthroplasty
- C reactive protein and skin temperature post total knee replacement.
- A Simple, Cost-Effective Screening Protocol to Rule Out Periprosthetic Infection
-
aspiration: gram stain, cell count & culture:
- most accurate method of dx, and is required prior to all revisions;
-
synovial fluid analysis:
-
white cell count greater than 10,000/mm may indicate sepsis, when the majority of cells are PMN's;
- references:
-
Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection.
-
Preoperative testing for sepsis before revision total knee arthroplasty.
-
Determining “True” Leukocytosis in Bloody Joint Aspiration
-
Cell Count and Differential of Aspirated Fluid in the Diagnosis of Infection at the Site of Total Knee Arthroplasty
-
gram stain: (see
bacterial menu);
- be aware that the quality of the gram stain result depends to a degree on the quality of the technician performing the test;
-
gram negative bacilli:,
gram negative cocci:,
gram positive bacilli:,
gram positive cocci
- ref:
-
Gram stain detection of infection during revision arthroplasty
-
The role of intraoperative Gram stain in revision total joint arthroplasty.
-
The role of intraoperative gram stain in the diagnosis of infection during revision total hip arthroplasty.
-
cultures:
- false positive results:
- cultures which show growth in broth only are generally not considered positive (probable lab error);
- when cultures are taken at time of revision, surgeon should be suspicious if only one sample (out of many) grows a pathogen (generally 2 positive culture
samples are required to indicate a definite infection);
- some surgeons require that a sample yield 5 colonies per plate inorder to indicate infection;
- false-negatives
- 25% false neg result w/ aspiration rate means that positive cultures often will be isolated only after components are removed & tissue is cultured;
- there is some evidence that false negatives may mainly include staph epidermidis;
- ref:
Molecular Identification of Bacteria from Aseptically Loose Implants
- references:
-
Improved aero-anaerobe recovery from infected prosthetic joint samples taken from 72 patients and collected intraop in Rosenow's broth.
-
The value of pre-operative aspiration in the diagnosis of an infected prosthetic knee: a retrospective study and review of literature.
-
Aspiration of the knee joint before revision arthroplasty.
-
The value of preoperative knee aspiration and arthroscopic biopsy in revision total knee arthroplasty
-
Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of 202 revision THR.
-
The Coventry Award. The value of preoperative aspiration before total knee revision.
-
Biofilm Theory Can Guide the Treatment of Device-Related Orthopaedic Infections.
-
Is Aseptic Loosening Truly Aseptic?
-
The Coventry Award. The value of preoperative aspiration before total knee revision.
-
Role of knee aspiration after resection of the infected total knee arthroplasty.
-
Is "aseptic" loosening of the prosthetic cup after THR due to nonculturable bacterial pathogens in patients with low-grade infection?
-
Sonication of removed hip and knee prostheses for diagnosis of infection.
- intra-operative frozen section:
- peri-implant membrane: high concentration of neutrophils is essentially diagnostic of ongoing infection;
- references for nasal swabbing:
- Use of Intranasal Mupirocin and Chlorhexidine Bathing and Incidence of MRSA Colonization and Infection Among ICU Patients.
- The role of MRSA screening in joint-replacement surgery.
- Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control.
- Preop use of mupirocin for the prevention of healthcare-associated Staphylococcus aureus infections: a cost-effectiveness analysis.
- Controlling the usage of intranasal mupirocin does impact the rate of Staphylococcus aureus deep sternal wound infections in cardiac surgery patients.
Sonication of Removed Hip and Knee Prostheses for Diagnosis of Infection
