Contribution of laboratory tests, scintigraphy, and histology to the diagnosis of lower limb joint replacement infection.
OBJECTIVE
To evaluate the contribution of laboratory tests, histology and scintigraphy for diagnosing and monitoring the treatment of lower limb arthroplasty infection.


METHODS
37 lower limb arthroplasties, 20 at the hip and 17 at the knee, were studied. Investigations included laboratory tests for inflammation (erythrocyte sedimentation rate, C-reactive protein, haptoglobin, and orosomucoid), histology (presence of neutrophils) and scintigraphy (99m Tc-HMDP bone scan, colloidal sulfide bone marrow scan, and 99m Tc-HMPAO leukocyte scan). Follow-up was at least three years after treatment of the infection.


RESULTS
Acute phase reactants were more sensitive and more specific than the erythrocyte sedimentation rate. The full scintigraphy protocol had 100% sensitivity and 87% specificity. Recovery of neutrophils by aspiration or during surgery was 100% specific in the absence of hematomas or rheumatoid arthritis. Sensitivity of the presence of neutrophils varied with the collection technique.
Department of Orthopedics and Traumatology, Caen Teaching Hospital, France.
M H
MH
Rosas
S
S
Leclercq
M
M
Pégoix
Y
Y
Darlas
J H
JH
Aubriot
P
P
Rousselot
C
C
Marcelli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D019411:Clinical Laboratory Techniques; D005500:Follow-Up Studies; D006242:Haptoglobins / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D009961:Orosomucoid / Q000378:metabolism; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D019690:Technetium Tc 99m Exametazime; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives
D006242:Haptoglobins; D009961:Orosomucoid; D019690:Technetium Tc 99m Exametazime; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D002097:C-Reactive Protein; D013669:Technetium Tc 99m Medronate