Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection

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• 作者：Eric H. Tischler ; BA^a ; Darren R. Plummer ; MD ; MBA^b ; Antonia F. Chen ; MD ; MBA^a ; Craig J. Della Valle ; MD^b ; Javad Parvizi ; MD ; FRCS^a ;
• 关键词：metal-on-metal ; corrosion ; total joint arthroplasty ; leukocyte esterase ; periprosthetic joint infection ; revision
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：31
• 期：10
• 页码：2260-2263
• 全文大小：202 K

文摘

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.

Methods

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).

Results

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.

Conclusion

++ LE strip test, in conjunction with preoperative work-ups, reliably rules out infection in 92.9% of patients undergoing THA revision secondary to ALTR.