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Seronegative infections in hip and knee arthroplasty

机译：髋关节和膝关节置换术的血清阴性感染

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The aim of our study was to describe the characteristics,treatment, and outcomes of patients with periprosthetic joint infection(PJI) and normal inflammatory markers after total knee arthroplasty(TKA) and total hip arthroplasty (THA). In total 538 TKAs and 414 THAs underwent surgical treatment forPJI and met the inclusion criteria. Pre-operative erythrocyte sedimentationrate (ESR) and C-reactive protein level (CRP) were reviewed to identifythe seronegative cohort. An age- and gender-matched cohort was identifiedfrom the remaining patients for comparison. Overall, 4% of confirmedinfections were seronegative (21 TKA and 17 THA). Of those who underwentpre-operative aspiration, cultures were positive in 76% of TKAs(n = 13) and 64% of THAs (n = 7). Cell count and differential weresuggestive of infection in 85% of TKA (n = 11) and all THA aspirates(n = 5). The most common organism was coagulase-negative Staphylococcus.Seronegative infections were associated with a lower aspirate cellcount and a lower incidence of Staphylococcus aureus infection.Two-stage revision was performed in 35 cases (95%). At a mean offive years (14 to 162 months) following revision, re-operation forinfection occurred in two TKAs, and one THA. From our study we estimatearound 4% of patients with PJI may present with normal ESR and CRP.When performed, pre-operative aspirate is useful in delivering adefinitive diagnosis. When treated, similar outcomes can be obtainedcompared with patients with positive serology.Cite this article: Bone Joint J 2015;97-B:939–44.
机译：本研究的目的是描述全膝关节置换术（TKA）和全髋关节置换术（THA）后假体周围感染（PJI）和炎症标记正常的患者的特征，治疗和结局。总共538例TKA和414例THA接受了PJI的手术治疗，并符合纳入标准。回顾了术前红细胞沉降率（ESR）和C反应蛋白水平（CRP），以鉴定血清阴性人群。从其余患者中鉴定出年龄和性别匹配的队列以进行比较。总体而言，确认感染的4％是血清阴性的（21 TKA和17 THA）。在接受术前抽吸的患者中，76％的TKA（n = 13）和64％的THA（n = 7）培养阳性。 85％的TKA（n = 11）和所有THA抽吸物（n = 5）的细胞计数和差异表明感染。最常见的生物是凝固酶阴性葡萄球菌，阴性感染与吸出细胞数减少和金黄色葡萄球菌感染的发生率较低有关，35例（95％）进行了两期翻修。修订后的平均分娩年数（14至162个月），有2例TKA和1例THA进行了再次感染手术。根据我们的研究，我们估计约有4％的PJI患者可能表现出正常的ESR和CRP。进行时，术前抽吸术有助于明确诊断。与血清学阳性的患者相比，如果接受治疗，可以获得相似的结果。引用本文：Bone Joint J 2015; 97-B：939-44。

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