title: Leukocyte esterase reagent strips for the rapid diagnosis of periprosthetic joint infection.
abstract: A total of 223 consecutive total hip or total knee arthroplasties were evaluated for periprosthetic joint infection (PJI) using leukocyte esterase reagent (LER) strips. Fifty-two LER strips were read as positive (23.3%), 106 were read as negative (47.5%), and 65 strips (29.2%) were unable to be read secondary to debris or blood in the aspiration. Using a synovial fluid white blood cell count of greater than 3000 white blood cell per microliter as an indicator of PJI, the sensitivity and specificity were 92.9% and 88.8%, respectively. When using positive cultures for diagnosis of PJI, sensitivity and specificity were 93.3% and 77.0% and 100% and 86.8% for the cases where a reoperation was performed and a combination of factors were used to define PJI. Leukocyte esterase reagent strips represent a rapid, inexpensive, and sensitive tool for the diagnosis of PJI. Their utility is limited, however, by blood or debris in the synovial fluid rendering them unreadable in one-third of cases.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA.
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Wetters
authors.forename: Keith R
authors.initials: KR
authors.lastname: Berend
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Morris
authors.forename: Tawnya L
authors.initials: TL
authors.lastname: Tucker
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Della Valle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002265:Carboxylic Ester Hydrolases / Q000032:analysis*; D004796:Clinical Enzyme Tests; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011934:Reagent Strips; D013997:Time Factors
chemical_list: D011934:Reagent Strips; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases