Aims. The purpose of this current multicentre study is to analyse the
presence of alpha-defensin proteins in synovial fluid using the
Synovasure lateral flow device and to determine its diagnostic reliability
and accuracy compared with the prosthetic joint infection (PJI)
criteria produced by the Musculoskeletal Infection Society (MSIS). Patients and Methods. A cohort of 121 patients comprising 85 total knee arthroplasties
and 36 total hip arthroplasties was prospectively evaluated between
May 2015 and June 2016 in three different orthopaedic centres. The
tests were performed on patients with a chronically painful prosthesis
undergoing a joint aspiration in a diagnostic pathway or during revision
surgery. Results. Based on the MSIS criteria, 34 patients (28%) would have had
a PJI, and 87 patients had no PJI. Testing with the lateral flow
device had a sensitivity of 97.1% (95% confidence intervals (CI)
84.5 to 99.9) and a specificity of 96.6% (95% CI 90.3 to 99.2).
The positive predictive value was 91.7% (95% CI 77.7% to 98.3),
and the negative predictive value was 98.8% (95% CI 93.6 to 99.9).
Receiver operator characteristics analysis demonstrated an area
under the curve for the Synovasure test of 0.97 (95% CI 0.93 to
1.00). Conclusion. Our findings suggest that the Synovasure test has an excellent
diagnostic performance to confirm or reject the
The
In many papers, the
Aims. This study aimed to assess the performance of an automated multiplex polymerase chain reaction (mPCR) technique for rapid
The causes of persistent symptoms after meniscectomy have been assessed clinically, radiologically and arthroscopically in 174 knees. The commonest finding was early degenerative arthritis (chondromalacia) of the femoral condyle (40 per cent). Retained fragments of meniscus were less common than expected (13 per cent), and lesions of the other meniscus were rare (5 per cent). The clinical
1. Forty-five cases of acute osteomyelitis have been reviewed with the object of determining the causes of relapse. The importance of an early
Although bone and soft-tissue sarcomas are rare, early
MRI was performed at three centres in Bombay on 24 patients clinically suspected of tuberculosis of the spine but with normal radiographs. There were 11 males and 13 females and their average age was 24 years (11 to 60). 99mTc bone scans were done in 16 patients before MRI. Eleven patients had the
Infection is a leading indication for revision
arthroplasty. Established criteria used to diagnose prosthetic joint infection
(PJI) include a range of laboratory tests. Leucocyte esterase (LE)
is widely used on a colorimetric reagent strip for the diagnosis
of urinary tract infections. This inexpensive test may be used for
the
Atlanto-axial rotatory fixation is one of a spectrum of rotatory abnormalities of the atlanto-axial joint. Rotatory fixation without anterior displacement of the atlas (Type I) has been reported in only a few cases in which there has been a prolonged interval between injury and
A retrospective study of 32 patients with primary tumours of the cauda equina is presented. Most of the patients were initially diagnosed as having prolapsed intervertebral discs and treated accordingly. The correct
Aims. The aim of this study was to determine the prevalence and characteristics of C-reactive protein (CRP)-negative prosthetic joint infection (PJI) and evaluate the influence of the type of infecting organism on the CRP level. Patients and Methods. A retrospective analysis of all PJIs affecting the hip or knee that were diagnosed in our institution between March 2013 and December 2016 was performed. A total of 215 patients were included. Their mean age was 71 years (. sd. 11) and there were 118 women (55%). The median serum CRP levels were calculated for various species of organism and for patients with acute postoperative, acute haematogenous, and chronic infections. These were compared using the Kruskal–Wallis test, adjusting for multiple comparisons with Dunn’s test. The correlation between the number of positive cultures and serum CRP levels was estimated using Spearman correlation coefficient. Results. Preoperative CRP levels were normal (< 10 mg/l) in 77 patients (35.8%) with positive cultures. Low-virulent organisms were isolated in 66 PJIs (85.7%) with normal CRP levels. When grouping organisms by species, patients with an infection caused by Propionibacterium spp., coagulase-negative staphylococci (CNS), and Enterococcus faecalis had significantly lower median serum CRP levels (5.4 mg/l, 12.2 mg/l, and 23.7 mg/l, respectively), compared with those with infections caused by Staphylococcus aureus and Streptococcus spp. (194 mg/l and 89.3 mg/l, respectively; p < 0.001). Those with a chronic PJI had statistically lower median serum CRP levels (10.6 mg/l) than those with acute postoperative and acute haematogenous infections (83.7 mg/l and 149.4 mg/l, respectively; p < 0.001). There was a significant correlation between the number of positive cultures and serum CRP levels (Spearman correlation coefficient, 0.456; p < 0.001). Conclusion. The CRP level alone is not accurate as a screening tool for PJI and may yield high false-negative rates, especially if the causative organism has low virulence. Aspiration of the joint should be used for the
A series of 100 patients with pain in the leg was studied and the accuracy of electrical studies in the
Cut-off values with highest sensitivity and specificity
for the synovial fluid white cell and differential count will facilitate
the accurate
Aims. The aim of this study was to establish the diagnostic accuracy
of culture of joint aspirate with and without saline injection-reaspiration. Patients and Methods. This is a retrospective analysis of 580 hip and knee aspirations
in patients who were deemed to have a moderate to high risk of infection,
and who subsequently proceeded to revision arthroplasty over a period
of 12 years. It was carried out at a large quaternary referral centre
where preoperative aspiration is routine. Results. Fluid was aspirated primarily in 313 (54%) cases and after saline
injection-reaspiration of a ‘dry tap’ in 267 (46%) cases. Overall
sensitivity and specificity of the diagnostic aspirate were 84%
(78% to 89%) and 85% (81% to 88%), respectively. Sensitivity and
specificity of saline injection-reaspiration after ‘dry tap’ were
87% (79% to 92%) and 79% (72% to 84%) compared with 81% (71% to
88%) and 90% (85% to 93%) for direct aspiration. Conclusion. Preoperative joint aspiration and culture is a sensitive and
specific test for the confirmation of
1. Direct injection of contrast material into bone indicates its extreme vascularity, particularly near an epiphysis, and emphasises the extraordinary capacity of the minute periosteal vessels. The nutrient artery of a long bone appears to play little part in its nourishment and may be regarded as a vestigeal structure. 2. The vascular pattern of bone tumours may be investigated by injection of the appropriate artery, and sometimes, if a haemangioma is suspected, by direct injection into the lesion. 3. The examination is easily and quickly carried out by direct arterial puncture under local anaesthesia and injection of 35 per cent diodone. A tourniquet applied distally at the appropriate level is often helpful. 4. A study of the vascular pattern of suspected bone tumours has provided useful information in a positive and negative way, assisting both the
1. The pathology of avascular necrosis of bone and its relationship to the radiographic changes are considered briefly. 2. The inadequacy of radiographic examination in the early
1. In the course of 2,668 operations for suspected cartilage lesions 119 errors of