Leukocyte esterase strip test as a reliable intraoperative PJIs biomarker. Our experience

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Paolo Di Benedetto
Giovanni Dalla Vecchia
Federico Dante
Renato Gisonni
Vanni Cainero
Araldo Causero


leukocyte, esterase, periprosthetic, joint, infection


ackgroud and aim of work: Prosthetic joint infection (PJI) is the most common cause of total knee replacement failure and the third most common cause of total hip replacement failure, accounting for 16.8% of all knee revisions and 14.8% of the hip revisions; nevertheless, the diagnosis of PJI is often a challenge for the orthopaedic surgeon. The aim of these study was to evaluate the reliability of the LE strip test for diagnosis of PJI. Materials and Methods: From December 2016 to January 2019, we enrolled 50 patients with suspected PJI; 32 females and 18 males, the average age at the time of the surgery was 76 years. Twenty-four patients underwent knee revision surgery and twenty-six hip revision surgery. In all patients during the surgery, the synovial fluid was aspirated and used for leukocyte esterase strip test. The result of the tests was compared to periprosthetic tissues culture, histological examination and sonication fluid culture for PJI. Results: Comparing the results obtained from the LE test with the results obtained from the other diagnostic methods, we found that the concordance between the results of the leukocyte-esterase test and those of the culture test with peri-prosthetic tissue or synovial fluid was shown to be 93%, between LE and histological examinations, the concordance was 93% and finally with the culture of the sonicated fluid the concordance was 86% of the cases. Conclusions: The results of our serie show a good intraoperative diagnostic accuracy of the LE test, especially in its ability to exclude the hypothesis of periprosthetic infection in case of a negative result.


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1. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27(8 Suppl):61-65 e61.
2. Di Benedetto P, Di Benedetto ED, Buttironi MM, De Franceschi D, Beltrame A, Gissoni R, et al. Two-stage revision after total knee arthroplasty. Acta Biomed 2017; 88(2 -S):92-97.
3. Bozic, K.J., Kurtz, S.M., Lau, E. et al. The epidemiology of revision total knee arthroplasty in the United States. ClinOrthopRelat Res. 2010; 468: 45
4. Ting NT1, Della Valle CJ2., Diagnosis of Periprosthetic Joint Infection-An Algorithm-Based Approach. , J Arthroplasty. 2017 Jul;32(7):2047-2050.
5. Matsen Ko L, Parvizi J., Diagnosis of Periprosthetic Infection: Novel Developments., Orthop Clin North Am. 2016 Jan;47(1):1-9.
6. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am 2010; 92(11):2102-2109.
7. Bejon P, Byren I, Atkins BL, Scarborough M, Woodhouse A, McLardy-Smith P, et al. Serial measurement of the C-reactive protein is a poor predictor of treatment outcome in prosthetic joint infection. J Antimicrob Chemother 2011; 66(7):1590-1593.
8. Bassetti M, Cadeo B, Villa G, Sartor A, Cainero V, Causero A. Current antibiotic management of prosthetic joint infections in Italy: the 'Udine strategy'. J Antimicrob Chemother 2014; 69 Suppl 1:i41-45.
9. Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Combined measurement of synovial fluid alpha-Defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am 2014; 96(17):1439-1445.
10. Bedair H, Ting N, Jacovides C, Saxena A, Moric M, Parvizi J, et al. The Mark Coventry Award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res 2011; 469(1):34-40.
11. Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am 2011; 93(24):2242-2248.
12. Wyatt MC, Beswick AD, Kunutsor SK, Wilson MJ, Whitehouse MR, Blom AW. The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2016; 98(12):992-1000.
13. Di Benedetto P, Buttironi MM, Causero A. Biomarkers and infections in orthopedics: our experience and literature review. J Biol Regul Homeost Agents. 2018 Nov-Dec;32(6 Suppl. 1): 51-5 6.
14. Di Benedetto P, Povegliano L, Cainero V, Gisonni R, Beltrame A, Causero A. The role of intraoperative frozen section in arthroplasty revision surgery: our experience. Acta Biomed 2016; 87 Suppl 1:34-40.
15. Saleh A, Ramanathan D, Siqueira MBP, Klika AK, Barsoum WK, Rueda CAH. The Diagnostic Utility of Synovial Fluid Markers in Periprosthetic Joint Infection: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg 2017; 25(11):763-772.
16. Lehrer RI, Ganz T. Defensins: endogenous antibiotic peptides from human leukocytes. Ciba Found Symp 1992; 171:276-290; discussion 290-273.

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