Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Two-stage component removal, antibiotic spacer placement and subsequent revision
20%
631/3091
Observation with repeat ESR and CRP in one week
16%
506/3091
Surgical debridement and polyethylene exchange only
4%
128/3091
Repeat aspiration and culture
56%
1720/3091
One-stage irrigation and debridement with exchange of all components
3%
88/3091
Select Answer to see Preferred Response
The clinical scenario describes a patient with an equivocal presentation of an infected total knee. The radiographs are normal and the bone scan shows uptake as would be expected 6 months out. A repeat aspiration is indicated in cases of equivocal laboratory aspiration data. Mason et al in 2003 reviewed 440 revision TKA's of which 86 had preoperative aspirations. The aspirations yield 55 aseptic failures and 31 septic failures. The mean WBC of the aseptic group was 645 cells/mm(3) compared to 25,951 cells/mm(3) for the septic group (P=<.001). The mean percentage of polymorphonuclear cells (PMNs) was statistically higher in the septic group compared with the aseptic group (72.8% vs 27.3%; P=<.001). With these results, the authors concluded that aspirates with a WBC count greater than 2,500 and 60% PMNs are highly suggestive of infection. Ghanem et al presents Level 3 evidence of 161 infected TKA's compared to 268 aseptic failures and discovered synovial fluid aspiration with WBC of >1100 cells/mm3 and PMN > 64% are suggestive of infection. When both tests were below these respective values, the negative predictive value was 98.2%.
2.6
(59)
Please Login to add comment