SynthesisInternational orthopaedics2018
The role of synovial fluid analysis in the detection of periprosthetic hip and knee infections: a systematic review and meta-analysis.
Synthesis in International orthopaedics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04858217 (Diagnostic Accuracy and Cost-effectiveness Analysis of Serum and Synovial Fluid Markers for the Diagnosis of Periprosthetic Hip and Knee Joint Infections), which is not on this map. Cited by 12 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Diagnostic Accuracy and Cost-effectiveness Analysis of Serum and Synovial Fluid Markers for the Diagnosis of Periprosthetic Hip and Knee Joint Infections
Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non-Inflammatory Arthritis Periprosthetic Joint Infection: A Meta-analysis and Systematic Review.Orthopaedic surgery · 2022Pooled it
- Meta-analysis in periprosthetic joint infection: a global bibliometric analysis.Journal of orthopaedic surgery and research · 2020Pooled it
- Does Aspiration With Culture Augmented With Percutaneous Core Biopsy Analysis Have Better Diagnostic Value Than Culture Alone for PJI in Large Joints? A Prospective Enhancement and Feasibility Study.Clinical orthopaedics and related research · 2026Article
- Synovial pH, lactate, and glucose as adjunct biomarkers to exclude periprosthetic joint infection in hip and knee arthroplasty: a prospective study.Journal of bone and joint infection · 2025Article
- Analysis of Serum and Synovial Inflammatory Markers in Periprosthetic Joint Infections: A Narrative Review.Cureus · 2024Review
- The optimal diagnostic cut-off of WBC and PMN counts for joint aspiration in periprosthetic joint infection is 2479/µL and 67%, respectively: ICM criteria thresholds are too high.Archives of orthopaedic and trauma surgery · 2023Article
- Is a preoperative pathogen detection a prerequisite before undergoing one-stage exchange for prosthetic joint infection of the hip?Archives of orthopaedic and trauma surgery · 2023Article
- Enhancing Diagnostics in Orthopedic Infections.Journal of clinical microbiology · 2022Review
- Evaluation and interpretation of prosthetic joint infection diagnostic investigations.International orthopaedics · 2021Review
- Twenty common errors in the diagnosis and treatment of periprosthetic joint infection.International orthopaedics · 2020Review
- Factors to Consider When Assessing the Diagnostic Accuracy of Synovial Leukocyte Count in Periprosthetic Joint Infection.Journal of bone and joint infection · 2019Review
- Six thousand papers already: "the outcome of a matter is better than its beginning…".International orthopaedics · 2018Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThis study tried to ascertain (1) the accuracy of synovial fluid white blood cell count and polymorphonucleate percentage in the diagnosis of periprosthetic hip and knee infections, (2) which test yielded superior test performance, and (3) the influence on diagnostic accuracy of study characteristics such as patient number, study design, study level, anatomic site, and threshold value.
methodsA systematic search was conducted including papers assessing more effective cutoffs for synovial fluid tests, having comparative design, evaluating an exclusive cohort of hip or knee prostheses, including a clear definition of infected cases, and reporting sufficient data for the calculation of true-positive, false-positive, false-negative, and true-negative.
resultsA total of 375 articles were collected and, given the inclusion criteria, ten manuscripts were included. These studies assessed 1155 hip prostheses (276 infected cases) and 1235 knee prostheses (401 infected cases). The specificity of synovial fluid white blood cell count was significantly increased by using the threshold value ≥ 3000 cell/μL (p = 0.006); the sensitivity of polymorphonucleate percentage was significantly higher in detecting knee infections (p = 0.034). DISCUSSION: Both tests had a high specificity and sensitivity in detecting periprosthetic joint infections, and no clear superiority of one over the other existed. Furthermore, cutoff and anatomic site significantly influenced synovial fluid white blood cell count and polymorphonucleate percentage, respectively.
conclusionSynovial fluid analysis is adequate in differentiating patients with periprosthetic hip and knee infections. Our data confirms international guidelines suggesting the use of 3000 cell/μL as cutoff threshold for synovial fluid white blood cell count. Since an anatomic site effect has been demonstrated, the goal of future studies will be to identify different cutoffs for hip and knee prostheses.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.