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Diagnosing Septic Arthritis in the Synovial White Cell Count “Gray Zone”

  • Evidence Based Review in Orthopedics
  • Published:
HSS Journal ®


Differentiating septic arthritis of the pediatric hip from other causes of hip pain and effusion continues to present a diagnostic challenge for the clinician. Although septic arthritis traditionally has been reported to have a synovial white blood cell count of 75,000 cells/mm3 or greater, lower counts can be seen in this condition. In cases where a synovial sample has been obtained and the cell count falls in the intermediate range between 25,000 and 75,000 cells/mm3, it is unclear what proportion of these cases may be truly septic hips. In this evidence-based review, we examine Heyworth et al’s study focusing on the predictive value of this intermediate white cell count range in a Lyme-endemic region.

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Joseph J. Ruzbarsky, MD, Brian P. Gladnick, MD and Emily Dodwell, MD, MPH, have declared that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

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Correspondence to Joseph J. Ruzbarsky MD.

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Ruzbarsky, J.J., Gladnick, B.P. & Dodwell, E. Diagnosing Septic Arthritis in the Synovial White Cell Count “Gray Zone”. HSS Jrnl 12, 190–192 (2016).

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