Acute Periprosthetic Joint Infections: Diagnostic Considerations View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2016-06-01

AUTHORS

Valentin Antoci , Hany Bedair , Craig J. Della Valle

ABSTRACT

Acute post-operative infections occur within first 6 weeks after surgery and are challenging to diagnose due to the heightened inflammatory state of normal healing. Wound erythema, fevers, and swelling may be expected findings in the early postoperative period and can be difficult to differentiate from infection, deep venous thrombosis, or other diagnoses. The first step in determining an accurate diagnosis is avoiding the administration of antibiotics until an appropriate evaluation for periprosthetic joint infection (PJI) has been performed.Recent work has shown that the serum C-reactive protein (CRP), while normally elevated in the early postoperative period, is an excellent screening test for identifying deep infection. Specifically, a serum CRP of greater than approximately 100 mg/L (normal <10 mg/L) has been shown to be an excellent screening test in the first 6 weeks postoperatively. If there is any question regarding an early infection, a serum CRP is obtained and if above or near this value, an arthrocentesis should be performed. The synovial fluid white blood cell count (WBC) and differential have been shown to be the best tests in the early postoperative period, albeit at threshold levels that are higher than those used for diagnosing chronic PJI. While in the setting of chronic PJI the typical threshold for the synovial fluid WBC count and differential is 3000 WBC/uL and 80 %, in the early postoperative period we utilize thresholds of greater than 10,000 WBC/uL and a differential of greater than 90 %. If the diagnosis is still unclear, cultures obtained from the aspirated fluid can be observed to confirm or refute the diagnosis of PJI. More... »

PAGES

211-219

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-30091-7_18

DOI

http://dx.doi.org/10.1007/978-3-319-30091-7_18

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1041685784


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