Abstract
Synovial white blood cell (WBC) count and the percentage of polymorphonuclear leucocytes (PMN%) is one of the diagnostic criteria to diagnose a periprosthetic joint infection (PJI). Although the test is widely available, the diagnostic accuracy of proposed cut-off levels are influenced by several factors, such as: the affected joint, co-morbid conditions, the causative microorganism and the gathering and processing of samples in the laboratory. In this narrative review we provide an overview on how and to what extent these factors can affect the synovial WBC count and PMN% in synovial fluid.
Highlights
The diagnosis of a periprosthetic joint infection (PJI) is challenging especially for chronic PJIs
In a multicentre study performed by Shohat et al [64] that included 1,220 patients undergoing revision arthroplasty, thresholds for white blood cell (WBC) count associated with PJI in patients with and without inflammatory arthritis were 2,533 and 2,683 cells/μL, respectively, and 73 and 72 for PMN%
The synovial WBC count result is only one of several diagnostic results that may lead to a definite diagnosis of PJI
Summary
The diagnosis of a periprosthetic joint infection (PJI) is challenging especially for chronic PJIs. They retrospectively reviewed preoperative aspiration data of 86 knees from 1986 to 1997 and calculated a specificity of 95% and sensitivity of 98% for diagnosing PJI when using a WBC count cut-off value of 2,500 cells/μL combined with a PMN% of > 60. Synovial WBC count cut-off values ranging from 1,000 to 5,000 cells/μL for the diagnosis of chronic hip and knee PJI have been published.
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