aaos guidelines infection work-up

AAOS GUIDELINES INFECTIONWORK-UP 2. We recommend erythrocyte sedimentation rate and C-reactive

protein testing for

patients assessed for periprosthetic joint infection.

Strength of Recommendation: Strong

3. We recommend joint aspiration of patients being assessed for periprosthetic knee

infections who have abnormal erythrocyte sedimentation rate AND/OR C-reactive

protein results. We recommend that the aspirated fluid be sent for microbiologic

culture, synovial fluid white blood cell count and differential.


AAOS GUIDELINES FOR INFECTION WORK-UP

9. Nuclear imaging (Labeled leukocyte imaging combined with bone or bone marrow

imaging, FDG-PET imaging, Gallium imaging, or labeled leukocyte imaging) is an

option in patients in whom diagnosis of periprosthetic joint infection has not been

established and are not scheduled for reoperation.

Strength of Recommendation: Weak

AAOS GUIDELINES INFECTIONWORK-UP 11. We recommend against the use of

intraoperative Gram stain to rule out periprosthetic

joint infection. Strength of Recommendation: Strong 12. We recommend the use of frozen sections of

peri-implant tissues in patients who are undergoing reoperation for whom the diagnosis

of periprosthetic joint infection has not been established or excluded. Strength of Recommendation: Strong

AAOS GUIDELINES INFECTIONWORK-UP

13. We recommend that multiple cultures be obtained at the time of reoperation in patients

being assessed for periprosthetic joint infection.


14. We recommend against initiating antibiotic treatment in patients with suspected

periprosthetic joint infection until after cultures from the joint have been obtained.


Leucocyte Esterase

Scientific Articles | December 21, 2011 Diagnosis of Periprosthetic Joint Infection: The

Utility of a Simple Yet Unappreciated Enzyme Javad Parvizi, MD, FRCS1; Christina Jacovides,

BS1; Valentin Antoci, MD, PhD1; Elie Ghanem, MD1

1 Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for J. Parvizi: [email protected]

Leukocyte Esterase

Results: On the basis of clinical, serological, and operative criteria, thirty of the 108 knees undergoing revision arthroplasty were infected and seventy-eight were uninfected. When only a ++ reading was considered positive, the leukocyte esterase test was 80.6% sensitive (95% confidence interval [CI], 61.9% to 91.9%) and 100% specific (95% CI, 94.5% to 100.0%), with a positive predictive value of 100% (95% CI, 83.4% to 100.0%) and a negative predictive value of 93.3% (95% CI, 85.4% to 97.2%). The leukocyte esterase level correlated strongly with the percentage of polymorphonuclear leukocytes (r = 0.7769) and total white blood-cell count (r = 0.5024) in the aspirate as well as with the erythrocyte sedimentation rate (r = 0.6188) and C-reactive protein level (r = 0.4719) in the serum.

MOM HIP WORK UP

GET XRAYS, EXAMINE PT

LOOK FOR MECHANICAL FAILURE

KNOW RECALLS( ASR, DUROM)

LOOK FOR ABNORMAL ANTERVERSION OR HIGH ADB ANGLE

MEASURE IONS(>5-7 PPb)

REVISE IF PAINFUL

DO MARS MRI OR ULTRASOUND TO LOOK FOR PSEUDO TUMORS

aaos guidelines infection work-up

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