Preoperative testing for sepsis before revision total knee arthroplasty.
One hundred five consecutive painful knee arthroplasties were evaluated by a single surgeon for the presence of infection using a uniform protocol that included an erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), perioperative aspiration with synovial fluid white blood cell (WBC) count and differential, intraoperative frozen section analysis, and culture. A synovial fluid WBC count of greater than 3000 was the most precise test with a sensitivity of 100%, specificity of 98%, and accuracy of 99%. The preoperative use of an ESR and CRP proved to be an excellent screening modality with only one infection identified with both values being normal. A rational approach to perioperative testing for sepsis includes a screening ESR and CRP, and if elevated, aspiration with synovial fluid WBC count or an intraoperative frozen section.
Della Valle
Craig J
CJ
Department of Orthopaedic Surgery, Rush Uiversity Medical Center, Chicago, Illinois 60612, USA.
Sporer
Scott M
SM
Jacobs
Joshua J
JJ
Berger
Richard A
RA
Rosenberg
Aaron G
AG
Paprosky
Wayne G
WG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012086:Reoperation; D012680:Sensitivity and Specificity; D013582:Synovial Fluid / Q000166:cytology