Leukocyte Esterase Reagent Strips for the Rapid Diagnosis of Periprosthetic Joint Infection

• Published in: The Journal of arthroplasty Vol. 27; no. 8; pp. 8 - 11
• Main Authors: Wetters, Nathan G., BS, Berend, Keith R., MD, Lombardi, Adolph V., MD, Morris, Michael J., MD, Tucker, Tawnya L., MT, Della Valle, Craig J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2012
• Subjects: Adult; Aged; Aged, 80 and over; Carboxylic Ester Hydrolases - analysis; Clinical Enzyme Tests; Female; Hip Prosthesis - adverse effects; Humans; Knee Prosthesis - adverse effects; Male; Middle Aged; Orthopedics; periprosthetic joint infection; Prospective Studies; Prosthesis-Related Infections - blood; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - etiology; Reagent Strips; Time Factors; total hip arthroplasty; total knee arthroplasty; periprosthetic joint infection; total hip arthroplasty; total knee arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2012.03.037

Abstract A total of 223 consecutive total hip or total knee arthroplasties were evaluated for periprosthetic joint infection (PJI) using leukocyte esterase reagent (LER) strips. Fifty-two LER strips were read as positive (23.3%), 106 were read as negative (47.5%), and 65 strips (29.2%) were unable to be read secondary to debris or blood in the aspiration. Using a synovial fluid white blood cell count of greater than 3000 white blood cell per microliter as an indicator of PJI, the sensitivity and specificity were 92.9% and 88.8%, respectively. When using positive cultures for diagnosis of PJI, sensitivity and specificity were 93.3% and 77.0% and 100% and 86.8% for the cases where a reoperation was performed and a combination of factors were used to define PJI. Leukocyte esterase reagent strips represent a rapid, inexpensive, and sensitive tool for the diagnosis of PJI. Their utility is limited, however, by blood or debris in the synovial fluid rendering them unreadable in one-third of cases.