{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:41:01Z","timestamp":1778496061034,"version":"3.51.4"},"reference-count":27,"publisher":"Royal College of Surgeons of England","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Currently there is no single test for periprosthetic joint infection (PJI) that demonstrates an acceptable level of sensitivity. The aim of this pilot study was to identify a combination of biomarkers that could exclude periprosthetic infection prior to revision surgery in hip and knee arthroplasty. This would help in equivocal cases of PJI, such as those with low-virulence organisms, chronic low-grade infection or \u2018aseptic\u2019 loosening. Current research has focused on measuring the levels of biomarkers in the patient\u2019s synovial fluid, and these can be combined to improve accuracy. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> We selected synovial white cell count (SF-WCC) and C-reactive protein (SF-CRP), as they demonstrated an acceptable level of sensitivity and specificity which could be measured using existing equipment. One hundred and sixty-one synovial fluid samples from 134 patients were collected and analysed prospectively using calculated cut-off values of 10mg\/l for SF-CRP and 3,000\u00d710<jats:sup>6<\/jats:sup>\/l for SF-WCC. Samples were deemed positive for infection when either of the SF-CRP or SF-WCC values were above the cut-off. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> The combined test demonstrated a sensitivity greater than 98.5% and specificity above 80% in all samples analysed or looked at separately for total hip replacement and total knee replacement infections. All ten aspirates taken from chronically infected joints tested positive. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> The combination of SF-CRP and SF-WCC measurement has been shown to have high sensitivity of over 99% in detecting both acute and chronic PJI in both hip and knee arthroplasty. This ability of the test to exclude infection with a high degree of certainty will help in preoperative planning of PJIs. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2021.0186","type":"journal-article","created":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T23:31:27Z","timestamp":1651361487000},"page":"334-339","source":"Crossref","is-referenced-by-count":6,"title":["The combined measurement of synovial markers in the diagnosis of periprosthetic joint infection"],"prefix":"10.1308","volume":"104","author":[{"given":"A","family":"Felstead","sequence":"first","affiliation":[{"name":"Frimley Health NHS Foundation Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Kundasamy","sequence":"additional","affiliation":[{"name":"Frimley Health NHS Foundation Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Penfold","sequence":"additional","affiliation":[{"name":"Frimley Health NHS Foundation Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Whiting","sequence":"additional","affiliation":[{"name":"Frimley Health NHS Foundation Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Buck","sequence":"additional","affiliation":[{"name":"Frimley Health NHS Foundation Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Sturridge","sequence":"additional","affiliation":[{"name":"Frimley Health NHS Foundation Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Meda","sequence":"additional","affiliation":[{"name":"Frimley Health NHS Foundation Trust, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"171","reference":[{"key":"C1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0471-5"},{"key":"C2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000143559.34143.3d"},{"key":"C3","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01199"},{"key":"C4","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2013.066"},{"key":"C5","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.97B2.34550"},{"key":"C6","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24766"},{"key":"C7","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.18.00632"},{"key":"C8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis966"},{"key":"C9","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-2102-9"},{"key":"C10","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-1971-2"},{"key":"C11","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-3722-7"},{"key":"C12","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-4904-8"},{"key":"C13","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.05.033"},{"key":"C14","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0295.R1"},{"key":"C15","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2018.1444301"},{"key":"C16","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.00123"},{"key":"C17","first-page":"345","volume":"27","author":"Gewurz H","year":"1982","journal-title":"Adv Intern Med"},{"key":"C18","doi-asserted-by":"publisher","DOI":"10.4103\/0366-6999.187857"},{"key":"C19","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-010-1175-5"},{"key":"C20","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.95B4.30388"},{"key":"C21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0084751"},{"key":"C22","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00470"},{"key":"C23","doi-asserted-by":"publisher","DOI":"10.4103\/0301-4738.37595"},{"key":"C24","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.20.00257"},{"key":"C25","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.1.160019"},{"key":"C26","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.02.078"},{"key":"C27","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.01646"}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2021.0186","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T10:47:15Z","timestamp":1684147635000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2021.0186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1308\/rcsann.2021.0186"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2021.0186","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}