USE OF BIOMARKERS AND CELL COUNT ON SYNOVIAL FLUID IN THE DIAGNOSIS OF PROSTHETIC JOINT INFECTION

Aim We report on the performance of a simple algorithm using a combination of synovial fluid White blood cell count(WBC), C-reactive protein(CRP) and α-Defensin(AD) tests to aid in the diagnosis of prosthetic joint infections. Methods Sixty-six synovial fluid samples were collected prospectively in patients with suspected PJI (hip and knee). All samples were tested by: WBC counts (read manually) and CRP test (Alere-Afinion™ validated in-house); and on 37 of these with AD test. Synovial fluid samples were collected in 5 ml ethylenediaminetetraacetic acid (EDTA) tubes. Samples that were very viscous were pre-processed by the addition of 100µl of hyaluronidase solution. Grossly blood stained and clotted samples were excluded. A clinical diagnosis of infection was based IDSA definitions1. Cut offs of >3000 × 106 cells/L for total synovial WBC count and >12mg/L for CRP were used to define infection2,3. Results Of 66 samples tested, 20 samples were categorised as clinically infected. Combination of WBC count an...