Articles | Volume 10, issue 3
https://doi.org/10.5194/jbji-10-165-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-165-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
14 May 2025
Original full-length article |
| 14 May 2025
| 14 May 2025
Differential synovial fluid white blood cell count for the diagnosis of chronic peri-prosthetic joint infection – a systematic review and meta-analysis
Orthopedic and Traumatology Department, Clínic Barcelona. Carrer Villarroel 170, 08036 Barcelona, Spain
Martin Clauss
Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland
Department for Orthopaedics and Trauma Surgery, University Hospital Basel, Basel, Switzerland
Ana Ribau
Unidade Local de Sáude do Médio Ave, Famalicao, Portugal
Ricardo Sousa
Porto Bone and Joint Infection Group (GRIP), ULS Santo António – Porto and CUF hospitals, Porto and Lisbon, Portugal
A full list of authors appears at the end of the paper.
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This is a retrospective diagnostic study in acute postoperative prosthetic joint infection in total knee arthroplasty that wants to determine diagnostic accuracy of synovial glucose and serum-to-synovial glucose ratio in acute postoperative infection. Both tests demonstrated good diagnostic potential. Notably, these biomarkers exhibited superior accuracy compared to the combination of C-reactive protein, synovial white blood cell count and polymorphonuclear percentage.
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We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
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When we initiated this paper, there was no evidence on what kind of spacers we should use. Our work was to prove that we must use a broad spectrum of antibiotics at the spacers in two-stage revision procedures. We demonstrate that a large spectrum of antibiotics at the spacer results in a lower rate of positive cultures during preimplantation and, subsequently, better outcomes and lower rate of infection.
Related subject area
Subject: Arthroplasty | Topic: All topics
Total hip arthroplasty performed in summer is not associated with increased risk of revision due to prosthetic joint infection: a cohort study on 58 449 patients with osteoarthritis from the Danish Hip Arthroplasty Register
Viewpoint: Periprosthetic joint infection and dental antibiotic prophylaxis guidelines
Rajzan Joanroy, Jens Kjølseth Møller, Sophie Gubbels, Søren Overgaard, and Claus Varnum
J. Bone Joint Infect., 9, 1–8, https://doi.org/10.5194/jbji-9-1-2024, https://doi.org/10.5194/jbji-9-1-2024, 2024
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This study investigated the association between summer and the risk of revision due to prosthetic joint infection (PJI) following primary total hip arthroplasty (THA) in a large Danish nationwide cohort in a temperate northern European climate. There is no association between primary THA performed during the summer compared to the rest of the year and the risk of revision due to PJI. In perspective, it seems that the northern European climate does not influence the risk of PJI.
Miao Xian Zhou, Elie F. Berbari, Cory G. Couch, Scott F. Gruwell, and Alan B. Carr
J. Bone Joint Infect., 6, 363–366, https://doi.org/10.5194/jbji-6-363-2021, https://doi.org/10.5194/jbji-6-363-2021, 2021
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This was written to outline Mayo Clinic guidelines on prophylactic antibiotics prior to invasive procedures in patients with prosthetic joints. There is an emphasis on maintaining optimal oral health to reduce the risk of infection to minimize the patient’s risk of PJI.
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Short summary
This meta-analysis evaluates synovial fluid white blood cell count and polymorphonuclear neutrophil proportion in order to diagnose chronic peri-prosthetic joint infection. Based on 74 studies, it identifies optimal thresholds, with rule-in and rule-out thresholds enhancing diagnostic precision. Confounding factors such as fractures and inflammatory arthritis are addressed. The findings support standardized diagnostic frameworks in improving accuracy and clinical consistency.
This meta-analysis evaluates synovial fluid white blood cell count and polymorphonuclear...
