title: Diagnosis of infected total knee: findings of a multicenter database.
abstract: Although total knee arthroplasty (TKA) is an effective and successful procedure, the outcome is occasionally compromised by complications including periprosthetic joint infection (PJI). Accurate and early diagnosis is the first step in effectively managing patients with PJI. At the present time, diagnosis remains dependent on clinical judgment and reliance on standard clinical tests including serologic tests, analysis of aspirated joint fluid, and interpretation of intraoperative tissue and fluid test results. Although reports regarding sensitivity and specificity of all diagnostic tests in the literature are abundant, the interpretation of the available data has been hampered by the low sample size of these studies. In view of the scope of this important problem and the limitations of previous reports, a large database was assembled of all revision TKA performed at three academic referral centers in order to determine the current status of diagnosis of the infected TKA utilizing commonly available tests. Intraoperative cultures should not be used as a gold standard for PJI owing to high percentages of false-negative and false-positive cases. When combined with clinical judgment, total white cell count and percentage of neutrophils in the synovial fluid more accurately reflects PJI and when combined with hematologic exams safely excludes or confirms infection.
  
  
  METHODS
  Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Elie
authors.initials: E
authors.lastname: Ghanem
authors.forename: Peter
authors.initials: P
authors.lastname: Sharkey
authors.forename: Ajay
authors.initials: A
authors.lastname: Aggarwal
authors.forename: R Stephen J
authors.initials: RS
authors.lastname: Burnett
authors.forename: Robert L
authors.initials: RL
authors.lastname: Barrack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001419:Bacteria / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
references.citation: Arch Orthop Trauma Surg. 2000;120(10):570-4
references.pmid: 11110138
references.citation: J Bone Joint Surg Am. 2006 Dec;88 Suppl 4:138-47
references.pmid: 17142443
references.citation: J Bone Joint Surg Am. 2007 Jul;89(7):1409-16
references.pmid: 17606776
references.citation: Arch Orthop Trauma Surg. 2005 Jun;125(5):322-9
references.pmid: 15821896
references.citation: Clin Orthop Relat Res. 1982 Oct;(170):175-83
references.pmid: 7127944
references.citation: Clin Orthop Relat Res. 2007 Aug;461:44-7
references.pmid: 17452914
references.citation: Clin Orthop Relat Res. 2004 Mar;(420):26-31
references.pmid: 15057075
references.citation: J Arthroplasty. 2007 Sep;22(6 Suppl 2):94-9
references.pmid: 17823025
references.citation: J Arthroplasty. 2008 Jan;23(1):65-8
references.pmid: 18165031
references.citation: Anesthesiology. 2002 May;96(5):1140-6
references.pmid: 11981154
references.citation: J Arthroplasty. 2000 Dec;15(8):990-3
references.pmid: 11112192
references.citation: J Clin Microbiol. 1999 Oct;37(10):3281-90
references.pmid: 10488193
references.citation: J Bone Joint Surg Am. 2006 Apr;88(4):869-82
references.pmid: 16595481
references.citation: Clin Orthop Relat Res. 2006 May;446:22-8
references.pmid: 16672867
references.citation: J Bone Joint Surg Br. 2006 Jul;88(7):943-8
references.pmid: 16799001
references.citation: Clin Orthop Relat Res. 2006 Nov;452:28-34
references.pmid: 16936585
references.citation: Anesthesiology. 2003 Sep;99(3):552-60; discussion 5A
references.pmid: 12960538
references.citation: Clin Orthop Relat Res. 2006 Feb;443:266-72
references.pmid: 16462450
references.citation: Am J Med. 2004 Oct 15;117(8):556-62
references.pmid: 15465503
references.citation: Clin Orthop Relat Res. 2005 Aug;(437):55-8
references.pmid: 16056026
references.citation: Clin Orthop Relat Res. 2002 Nov;(404):7-13
references.pmid: 12439231
references.citation: J Arthroplasty. 2003 Dec;18(8):1038-43
references.pmid: 14658109
references.citation: J Bone Joint Surg Am. 1999 May;81(5):672-83
references.pmid: 10360695