Advertisement

Synovial Fluid Cytology

  • René MihaličEmail author
  • Dunja Terčič
Chapter

Abstract

In the evaluation of artificial joint disorders, synovial fluid analysis can become a very efficient diagnostic tool. This chapter explains the role of synovial fluid cytological analysis in diagnosing prosthetic joint infection (PJI). Recommended cutoff values for diagnosing PJI for leukocyte count are 1,700 cells/μL and for neutrophils 65 %. Considering those cutoff values for diagnosing PJI, the specificity is very high, exceeding 90 %, which means that negative cytological result of synovial fluid analysis indicates absence of infection. The results are comparable to intraoperative tissue cultures and histopathology, which are frequently used as reference standard diagnostic markers in diagnosing prosthetic joint infection.

Keywords

Synovial fluid Leukocytes Neutrophils Cytology Diagnosis 

References

  1. 1.
    Kurtz SM, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–54.PubMedCrossRefGoogle Scholar
  3. 3.
    del Pozo JL, Patel R. Clinical practice. Infection associated with prosthetic joints. N Engl J Med. 2009;361:787–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006;88 Suppl 4:138–47.PubMedCrossRefGoogle Scholar
  5. 5.
    Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117:556–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Terčič D, Božič B. The basis of the synovial fluid analysis. Clin Chem Lab Med. 2001;39:1221–6.PubMedGoogle Scholar
  7. 7.
    Clohisy JC, Lindskog D, Abu-Amer Y. Bone and joint biology. In: Lieberman JR, editor. AAOS comprehensive orthopaedic review. Rosemont: American Academy of Orthopaedic Surgeons; 2009.Google Scholar
  8. 8.
    Brinker MR, O’Connor DP. Basic sciences. In: Miller MD, editor. Review of orthopaedics. Philadelphia: Saunders Elsevier; 2008.Google Scholar
  9. 9.
    Baker DG, Schumacher Jr HR. Acute monoarthritis. N Engl J Med. 1993;329:1013–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. American College of Rheumatology Ad hoc Committee on Clinical Guidelines. Arthritis Rheum. 1996;39:1–8.Google Scholar
  11. 11.
    An YH, Friedman RJ. Concise review of mechanisms of bacterial adhesion to biomaterial surfaces. J Biomed Mater Res. 1998;43:338–48.PubMedCrossRefGoogle Scholar
  12. 12.
    Zalavras CG, Costerton JW. Biofilm, biomaterials and bacterial adherence. In: Cierny G, McLaren AC, Wongworawat MD, editors. Orthopaedic knowledge update: musculoskeletal infection. Rosemont: American Academy of Orthopaedic Surgeons; 2009.Google Scholar
  13. 13.
    Ceri H, Olson ME, Stremick C, Read RR, Morck D, Buret A. The Calgary biofilm device: new technology for rapid determination of antibiotic susceptibilities of bacterial biofilms. J Clin Microbiol. 1999;37:1771–6.PubMedGoogle Scholar
  14. 14.
    Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case control study. Clin Infect Dis. 1998;27:1247–54.PubMedCrossRefGoogle Scholar
  15. 15.
    Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JR, Cockerill FR, Steckelberg JM, Greenleaf JM, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Mason JB, Fehring TK, Odum SM, Griffin WL, Nussman DS. The value of white blood cell counts before revision total knee arthroplasty. J Arthroplasty. 2003;18:1038–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Della Valle CJ, Sporer SM, Jacobs JJ, Berger RA, Rosenberg AG, Paprosky WG. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty. 2007;22 Suppl 2:90–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Agarwal A, Barrack RL. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008;90:1637–43.PubMedCrossRefGoogle Scholar
  19. 19.
    Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am. 2008;90:1869–75.PubMedCrossRefGoogle Scholar
  20. 20.
    Ghanem E, Houssock C, Pulido L, Han S, Jaberi FM, Parvizi J. Determining “true” ­leukocytosis in bloody joint aspirate. J Arthroplasty. 2008;23:182–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Orthopaedic Hospital ValdoltraAnkaranSlovenia

Personalised recommendations