Application of leukocyte esterase strip test in the screening of periprosthetic joint infections and prospects of high-p
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Arthroplasty
REVIEW
Open Access
Application of leukocyte esterase strip test in the screening of periprosthetic joint infections and prospects of high-precision strips Qing-Yuan Zheng and Guo-Qiang Zhang*
Abstract Periprosthetic joint infection (PJI) represents one of the most challenging complications after total joint arthroplasty (TJA). Despite the availability of a variety of diagnostic techniques, the diagnosis of PJI remains a challenge due to the lack of well-established diagnostic criteria. The leucocyte esterase (LE) strips test has been proved to be a valuable diagnostic tool for PJI, and its weight in PJI diagnostic criteria has gradually increased. Characterized by its convenience, speed and immediacy, leucocyte esterase strips test has a prospect of broad application in PJI diagnosis. Admittedly, the leucocyte esterase strips test has some limitations, such as imprecision and liability to interference. Thanks to the application of new technologies, such as machine reading, quantitative detection and artificial intelligence, the LE strips test is expected to overcome the limitations and improve its accuracy. Keywords: Periprosthetic joint infections (PJI), Leukocyte esterase strips test, High-precision strips
Introduction Periprosthetic joint infection (PJI) is currently one of the most challenging problems in the field of joint surgery [1]. The overall incidence of PJI is low and stands at 1 to 3% [2–5]. However, with the population aging trend in China intensifies, the number of patients undergoing total joint arthroplasty has been on the rise. The increase in the patient base will inevitably lead to an increase in the number of PJI patients. The diagnosis and treatment of PJI are difficult and expensive, posing a heavy burden on the society at large [6, 7]. Nonetheless, not a definitive single “gold standard” is available for the diagnosis. Moreover, a variety of diagnosis modes are currently used and the discrepancies yielded by different modes present another problem [8, 9].
* Correspondence: [email protected] Department of Orthopedics, the Fourth Medical Center, Chinese PLA General Hospital, 51 Fucheng Road, Beijing IL 60016, China
In 2018, International Consensus Meeting (ICM) was held in Philadelphia (U.S.), and the meeting worked out the ICM2018 International Consensus on Prosthetic Joint Infections [10]. Compared to the widely-used MSIS2014 diagnostic criteria, the new version remains essentially unchanged except for the inclusion of 2 main diagnostic indicators and, the division of the secondary diagnostic indicator divided into 4 parts: serological examination, synovial fluid analysis, microbial culture, and intraoperative indicators. Among these parts, in the analysis of synovial fluid, leukocyte esterase (LE) strip test is combined with leukocyte count and α-defensin detection. This revision weighs a lot in the new version of PJI diagnostic criteria [11]. LE strip test uses a plastic strip with filter paper containing indolyl carboxylate at one end. LE converts the substrate into i
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