ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2026
Lower synovial leucocyte count and polymorphonuclear percentage reliably differentiate periprosthetic joint infection after unicompartmental knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Synovial interleukin-6 point-of-care testing, alone and combined with D-dimer, supports rapid diagnosis of periprosthetic joint infection.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Key Inflammatory Pathways, Biomarkers, and Targeted Management Strategies in Primary Total Joint Arthroplasty: A Narrative Review.Medicina (Kaunas, Lithuania) · 2026Review
- Revision from unicompartmental knee arthroplasty to total knee arthroplasty: An analysis of 118 cases at midterm follow-up.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
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8 authors.
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Abstract
purposeThis study aimed to determine diagnostic thresholds for synovial fluid leucocyte count and polymorphonuclear (PMN) percentage to identify the diagnosis periprosthetic joint infection (PJI) in patients with failed unicompartmental knee arthroplasties (UKAs).
methodsThis multicentre retrospective cohort study included 239 patients who underwent revision of an UKA for either septic or aseptic indications at five university-affiliated medical centres. Among these, 30 patients (13%) underwent revision for PJI and 209 (87%) for noninfectious causes. PJI was diagnosed according to the European Bone and Joint Infection Society (EBJIS) criteria. Preoperative synovial fluid leucocyte count, synovial PMN percentage, serum C-reactive protein (CRP) and white blood cell (WBC) count were evaluated. Diagnostic performance and optimal thresholds for each parameter were assessed using receiver operating characteristic curves and Youden's index.
resultsThe PJI group demonstrated significantly higher median synovial leucocyte counts (11,399/μL vs. 429/μL, p < 0.001), and significantly higher synovial PMN percentage (82% vs. 28%, p < 0.001) compared to the non-PJI group. The optimal diagnostic cut-off for synovial fluid leucocyte count was 2318/μL (area under curve [AUC] 0.93; sensitivity 83%, specificity 95%) and for PMN percentage, 64% (AUC 0.90; sensitivity 76%, specificity 95%). Serum CRP (cut-off 9 mg/L; AUC 0.85) and WBC count (cut-off 8 G/L; AUC 0.71), showed lower diagnostic accuracy.
conclusionsThis study establishes UKA-specific diagnostic thresholds for PJI, which are consistent with the EBJIS PJI criteria established for TKA. Synovial biomarkers, particularly synovial fluid leucocyte count and PMN percentage, demonstrated superior diagnostic performance compared to serum CRP and WBC count. These findings underscore the need for tailored diagnostic criteria to improve the accuracy of PJI diagnosis and guide clinical decision-making in UKA revision. LEVEL OF EVIDENCE: Level III.
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