title: [Comparison and estimation of different diagnostic methods in detecting the presence of periprosthetic joint infection].
abstract: OBJECTIVE
  To compare and estimate the diagnostic value and characteristic of different diagnostic methods (blood laboratory test, histological analysis, synovial fluid cytological test and microbiological examination) in detecting the presence of periprosthetic joint infection.
  
  
  METHODS
  Data of 52 patients underwent hip or knee joint revision in Peking University People's Hospital Arthritis Clinic and Research Center between July 2013 and March 2015 were analyzed retrospectively. For each patient, results of blood laboratory tests(peripheral-blood white blood cell, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (Hs-CRP)), histological analysis, synovial fluid white cell count (SWCC), microbiological examinations (synovial fluid, tissue and prosthetic joint sonication fluid) were collected. Data were analyzed by t-test, independent sample median test or χ(2) test, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for each method were calculated and compared by receiver operating characteristic curve.
  
  
  RESULTS
  There were 30 female and 22 male patients. Twenty-one patients (40.4%) were diagnosed as PJI. The levels of CRP, ESR, IL-6 and Hs-CRP in patients with PJI were higher than that in aseptic failure patients (Z=23.084, 13.499, 5.796, 17.045, all P<0.05). The sensitivities of CRP, ESR, IL-6 and Hs-CRP were 90.5%, 81.0%, 95.0% and 90.0%. The sensitivities of histological analysis and SWCC were 55.0% and 70.6%, while they had high specificity as 89.7% and 85.7%. The sensitivity of sonication fluid culture was 90.0%, which was higher than that of tissue culture (71.4%) and synovial fluid culture (65.0%) (χ(2) = 5.333, 6.400, all P<0.05).
  
  
  CONCLUSIONS
  The tests of CRP, ESR, IL-6 and Hs-CRP have good value in detecting PJI preoperatively. Histological analysis and SWCC have high specificity, which could help to exclude PJI. Sonication fluid culture has a higher sensitivity than tissue culture and synovial fluid culture.
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Tang
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Shengfeng
authors.initials: S
authors.lastname: Wang
authors.forename: Qunjie
authors.initials: Q
authors.lastname: Zhong
authors.forename: Zhichang
authors.initials: Z
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Ke
authors.forename: Rujun
authors.initials: R
authors.lastname: Li
authors.forename: Hu
authors.initials: H
authors.lastname: Li
authors.forename: Jianhao
authors.initials: J
authors.lastname: Lin
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007719:Knee Joint; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013582:Synovial Fluid / Q000166:cytology
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein