Utility of synovial fluid aspirations in failed metal-on-metal total hip arthroplasty

Cody C. Wyles, Dirk R. Larson, Matthew T. Houdek, Rafael J. Sierra, Robert T. Trousdale

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


White blood cell (WBC) count and neutrophil percentage from preoperative synovial fluid aspirations are used to help determine the presence or absence of periprosthetic joint infection (PJI) in failed total hip arthroplasty (THA). The clinical levels indicative of infection have not been delineated in metal-on-metal (MoM) bearings. We identified 39 patients who received a preoperative synovial fluid aspiration prior to MoM revision. Thirty-five of 39 cases were culture negative and 4 of 39 were culture positive. WBC count > 3000 cells/μL was 100% sensitive and 57.1% specific. Neutrophil percentage > 80% was 100% sensitive and 97.1% specific. Both CRP and ESR > 8.0. mg/L and > 22 mm/h, respectively were 75.0% sensitive and 67.6% specific. Our data suggest that synovial WBC count and serum ESR and CRP have poor predictive value in diagnosing PJI for failed MoM THA, whereas synovial neutrophil percentage is a highly accurate marker for diagnosing infection in this patient population.

Original languageEnglish (US)
Pages (from-to)818-823
Number of pages6
JournalJournal of Arthroplasty
Issue number5
StatePublished - May 2013


  • Aspiration
  • Total hip arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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