Study of joint fluid for early detection of infections associated with hip arthroplasty

Abstract

Background: there are numerous studies and algorithms proposed to define the presence of infection in total hip replacement, among them the commonly used are Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These are serological markers, which are easily accessible, cheap, and their Specificity and Sensitivity are widely studied and known. On the other hand, we have arthrocentesis, with the following evaluation of synovial fluid. Through a systematic review of the existing studies, we will evaluate whether the execution of Postoperative Arthrocentesis in a preventive manner to anticipate a possible infection is not important, comparing these synovial markers with the previously mentioned serological ones (ESR and CRP).

Material and methods: systematic review of articles through PubMed. In the first instance, a brief investigation is carried out on the incidence of infection in total hip replacement. After this, we select articles from medical trials that study patients with total hip replacement who have had peri-implant infection and meet the criteria proposed by the Musculoskeletal Infections Society (MSIS), and also, which were evaluated by the markers Erythrocyte Sedimentation (ESR), C-Reactive Protein (CRP), Synovial White Blood Cells (WBC) and Synovial Polymorphonuclear (PMN). Then these collected data were entered into an Excel table, comparing each one of them, and thus being able to have an average, defining if it is really worth performing immediate post-operative arthrocentesis in order to prevent or diagnose an infection early.

Conclusion: although each of the studies analyzed have different cut-off values for each of the markers analyzed, we can observe that both the Specificity and the Sensitivity of the synovial fluid White Blood Cell count compared to the serological markers (CRP and ESR) are higher.