{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T05:59:33Z","timestamp":1794376773786,"version":"4.9.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T00:00:00Z","timestamp":1668816000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T00:00:00Z","timestamp":1668816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004869","name":"Westf\u00e4lische Wilhelms-Universit\u00e4t M\u00fcnster","doi-asserted-by":"publisher","award":["Open Access Funds"],"award-info":[{"award-number":["Open Access Funds"]}],"id":[{"id":"10.13039\/501100004869","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004869","name":"Westf\u00e4lische Wilhelms-Universit\u00e4t M\u00fcnster","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004869","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study\u2019s purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; <jats:italic>n<\/jats:italic>\u2009=\u200925) or knee (TKA, <jats:italic>n<\/jats:italic>\u2009=\u200967) were prospectively investigated. In our cohort 33% (30\/92) had PJI and 67% (62\/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden\u2019s index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off\u2009&gt;\u20093000 leukocytes) and percentage of neutrophils (PMN%, cut-off\u2009&gt;\u200980%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>2a, diagnostic study.<\/jats:p>\n                <jats:p><jats:italic>Trial registration<\/jats:italic> German Clinical Trials Register (Registration number: DRKS00021038).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s10195-022-00672-5","type":"journal-article","created":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T17:03:59Z","timestamp":1668877439000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection"],"prefix":"10.1186","volume":"23","clinical-trial-number":[{"clinical-trial-number":"drks00021038","registry":"10.18810\/drks"}],"author":[{"given":"Christoph","family":"Theil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Ackmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Gosheger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Puetzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Moellenbeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Schwarze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Schulze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Klingebiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,19]]},"reference":[{"key":"672_CR1","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1016\/j.arth.2015.03.035","volume":"30","author":"AF Kamath","year":"2015","unstructured":"Kamath AF, Ong KL, Lau E et al (2015) Quantifying the burden of revision total joint arthroplasty for periprosthetic infection. 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The trial was registered in the German clinical trials registry (Registration number: DRKS00021038). Approval by the local ethics committee was obtained as well prior to conducting the study (Ethikkommission der \u00c4rztekammer Westfalen Lippe und der Westf\u00e4lischen Wilhelms Universit\u00e4t M\u00fcnster, ref. no. 2019-666-f-S, approval granted 26.02.2020). The study was designed and conducted following the Equator Network statement.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent for publication was not deemed necessary as the manuscript does not contain individual data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"52"}}