Dynamics of Synovial Fluid Markers Following Single-Stage Exchange and Debridement, Antibiotics, and Implant Retention Procedure With Topical Antibiotic Infusion in Treating Periprosthetic Joint Infection

Wenbo Mu; Juan D Lizcano; Boyong Xu; Siyu Li; Xiaogang Zhang; Javad Parvizi; Li Cao

doi:10.1016/j.arth.2024.11.045

Dynamics of Synovial Fluid Markers Following Single-Stage Exchange and Debridement, Antibiotics, and Implant Retention Procedure With Topical Antibiotic Infusion in Treating Periprosthetic Joint Infection

J Arthroplasty. 2024 Nov 26:S0883-5403(24)01261-0. doi: 10.1016/j.arth.2024.11.045. Online ahead of print.

Authors

Wenbo Mu¹, Juan D Lizcano², Boyong Xu³, Siyu Li³, Xiaogang Zhang³, Javad Parvizi⁴, Li Cao⁵

Affiliations

¹ Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
² Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
³ Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
⁴ International Joint Center, Acibadem University Hospital, Istanbul, Turkey.
⁵ Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Key Laboratory of High Incidence Disease Research in Xingjiang, Xinjiang Medical University, Ministry of Education, Urumqi, Xinjiang, China; Xinjiang Clinical Research Center for Orthopedics, Urumqi, Xinjiang, China.

PMID: 39603366
DOI: 10.1016/j.arth.2024.11.045

Abstract

Background: Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty. This study aimed to investigate the dynamics of synovial fluid markers following single-stage exchange arthroplasty or debridement, combined with antibiotics and implant retention with topical antibiotic infusion for PJI.

Methods: This retrospective study analyzed patient records at a tertiary hospital from March 1, 2018, to May 1, 2023. Patients who received single-stage exchange arthroplasty or debridement, combined with antibiotics and implant retention, followed by intra-articular antibiotic infusion for PJI, were included. Basic demographic details, comorbidities, Charlson Comorbidity Index scores, microorganism profile, presence of sinus tract, and antibiotic treatment type were collected. Synovial fluid samples were collected preoperatively and postoperatively every two days for 14 days to quantify synovial white blood cell (WBC) count and polymorphonuclear cell percentage (PMN%).

Results: The study included 140 patients who had a mean age of 63 years and a mean body mass index of 25. The results showed a steady decrease in synovial WBC count from preoperative levels to day 14 postoperatively. Patients who had successful outcomes had significantly higher preoperative WBC counts compared to those who had a treatment failure. The synovial PMN% initially increased postoperatively, peaking at days one to two, and then gradually declined. Patients who had successful outcomes showed a faster decline in PMN% compared to those who had persistent infections. Different bacteria exhibited varying preoperative synovial WBC counts and PMN%, but these differences were not statistically significant.

Conclusions: Monitoring synovial WBC count and PMN% can help distinguish between normal postoperative inflammation and persistent infection. Higher preoperative synovial WBC counts are associated with successful outcomes, suggesting their potential role in predicting treatment success. Future research with larger sample sizes is necessary to further validate these findings and improve the management and diagnosis of PJI.

Keywords: debridement; implant retention; periprosthetic joint infection; single-stage exchange arthroplasty; synovial markers; topical antibiotic infusion.