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Preoperative Testing for Sepsis Before Revision Total Knee Arthroplasty

2007; Elsevier BV; Volume: 22; Issue: 6 Linguagem: Inglês

10.1016/j.arth.2007.04.013

1532-8406

Craig J. Della Valle, Scott M. Sporer, Joshua J. Jacobs, Richard A. Berger, Aaron G. Rosenberg, Wayne G. Paprosky,

Orthopaedic implants and arthroplasty

One hundred five consecutive painful knee arthroplasties were evaluated by a single surgeon for the presence of infection using a uniform protocol that included an erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), perioperative aspiration with synovial fluid white blood cell (WBC) count and differential, intraoperative frozen section analysis, and culture. A synovial fluid WBC count of greater than 3000 was the most precise test with a sensitivity of 100%, specificity of 98%, and accuracy of 99%. The preoperative use of an ESR and CRP proved to be an excellent screening modality with only one infection identified with both values being normal. A rational approach to perioperative testing for sepsis includes a screening ESR and CRP, and if elevated, aspiration with synovial fluid WBC count or an intraoperative frozen section.