Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection.
Adverse local tissue reactions (ALTRs) and periprosthetic joint infection can occur after metal-on-metal total hip arthroplasty (THA), both potentially generating purulent synovial fluid (SF) and elevated white cell count. This makes it difficult to distinguish between diagnoses; therefore, we evaluated leukocyte esterase (LE) strip test's reliability in ruling out periprosthetic joint infection in ALTR revision THA.



Sixty-one patients with ALTRs and an LE strip test were evaluated, excluding 15 cases with SF metallic debris. LE strip tests were classified -/trace, + (mildly positive), and ++ (strongly positive).



LE strip tests were ++, +, -/trace in 8 patients (13.1%), 14 (23.0%), and 39 (63.9%), respectively. Means and ranges of SF white cell count and polymorphonuclear percentage were 1291.4 (0-10,886 cells/μL), and 46.1% (0%-94%), respectively.



++ LE strip test, in conjunction with preoperative work-ups, reliably rules out infection in 92.9% of patients undergoing THA revision secondary to ALTR.
Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Eric H
EH
Tischler
Rush University Medical Center, Chicago, Illinois.
Darren R
DR
Plummer
Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Antonia F
AF
Chen
Rush University Medical Center, Chicago, Illinois.
Craig J
CJ
Della Valle
Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Javad
J
Parvizi
D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000175:diagnosis; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D002265:Carboxylic Ester Hydrolases / Q000032:analysis*; D005260:Female; D006801:Humans; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000209:etiology; D011934:Reagent Strips; D012086:Reoperation; D015203:Reproducibility of Results; D013582:Synovial Fluid
D008670:Metals; D011934:Reagent Strips; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases
corrosion; leukocyte esterase; metal-on-metal; periprosthetic joint infection; revision; total joint arthroplasty