Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infections

Abstract In the absence of standard criteria for prosthetic joint infections (PJI), several diagnostic modalities have been proposed mostly concentrating on novel biochemical markers. The physical chemistry markers received scarce attention. Synovial fluid (SF) viscosity could be considered as marke...

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Main Authors: Samo Roškar, René Mihalič, Anže Mihelič, Rihard Trebše
Format: Article
Language:English
Published: Nature Portfolio 2025-05-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-00760-6
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author Samo Roškar
René Mihalič
Anže Mihelič
Rihard Trebše
author_facet Samo Roškar
René Mihalič
Anže Mihelič
Rihard Trebše
author_sort Samo Roškar
collection DOAJ
description Abstract In the absence of standard criteria for prosthetic joint infections (PJI), several diagnostic modalities have been proposed mostly concentrating on novel biochemical markers. The physical chemistry markers received scarce attention. Synovial fluid (SF) viscosity could be considered as marker for PJI, however, its diagnostic value of PJI remains unknown. Our study aimed to determine the potential of SF viscosity as a diagnostic marker of PJI and compare it to SF cell count with differential (CCD). We prospectively analysed 123 SF samples (58 septic and 65 aseptic) for viscosity and CCD of SF obtained during hip and knee revision procedures. The diagnosis of PJI based on EBJIS criteria. The viscosity cut-off for PJI was calculated and the diagnostic power was compared to CCD. The mean SF viscosity in the PJI group was 8.5 ± 0.4 mPa s and 103.2 ± 18.8 mPa s in the aseptic group (p < 0.05). SF viscosity achieved 100% sensitivity and 85.3% specificity, with AUC 0.832 (95% CI 0.739, 0.925). Combination of SF viscosity and CCD achieved AUC 0.951 (95% CI 0.919, 0.987). SF viscosity is more sensitive but slightly less specific in diagnosing PJI than SF CCD. Best diagnostic value is achieved combining SF viscosity with CCD in detection of PJI.
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spelling doaj-art-aa3d2aec93764dc3ad9b25d24a42e5c22025-08-20T03:53:12ZengNature PortfolioScientific Reports2045-23222025-05-011511810.1038/s41598-025-00760-6Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infectionsSamo Roškar0René Mihalič1Anže Mihelič2Rihard Trebše3Valdoltra Orthopaedic HospitalValdoltra Orthopaedic HospitalValdoltra Orthopaedic HospitalValdoltra Orthopaedic HospitalAbstract In the absence of standard criteria for prosthetic joint infections (PJI), several diagnostic modalities have been proposed mostly concentrating on novel biochemical markers. The physical chemistry markers received scarce attention. Synovial fluid (SF) viscosity could be considered as marker for PJI, however, its diagnostic value of PJI remains unknown. Our study aimed to determine the potential of SF viscosity as a diagnostic marker of PJI and compare it to SF cell count with differential (CCD). We prospectively analysed 123 SF samples (58 septic and 65 aseptic) for viscosity and CCD of SF obtained during hip and knee revision procedures. The diagnosis of PJI based on EBJIS criteria. The viscosity cut-off for PJI was calculated and the diagnostic power was compared to CCD. The mean SF viscosity in the PJI group was 8.5 ± 0.4 mPa s and 103.2 ± 18.8 mPa s in the aseptic group (p < 0.05). SF viscosity achieved 100% sensitivity and 85.3% specificity, with AUC 0.832 (95% CI 0.739, 0.925). Combination of SF viscosity and CCD achieved AUC 0.951 (95% CI 0.919, 0.987). SF viscosity is more sensitive but slightly less specific in diagnosing PJI than SF CCD. Best diagnostic value is achieved combining SF viscosity with CCD in detection of PJI.https://doi.org/10.1038/s41598-025-00760-6Synovial fluid viscositySynovial fluid cell countTotal joint arthroplastyProsthetic joint infections
spellingShingle Samo Roškar
René Mihalič
Anže Mihelič
Rihard Trebše
Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infections
Scientific Reports
Synovial fluid viscosity
Synovial fluid cell count
Total joint arthroplasty
Prosthetic joint infections
title Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infections
title_full Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infections
title_fullStr Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infections
title_full_unstemmed Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infections
title_short Synovial fluid viscosity with synovial fluid cell count, valuable diagnostic marker of prosthetic joint infections
title_sort synovial fluid viscosity with synovial fluid cell count valuable diagnostic marker of prosthetic joint infections
topic Synovial fluid viscosity
Synovial fluid cell count
Total joint arthroplasty
Prosthetic joint infections
url https://doi.org/10.1038/s41598-025-00760-6
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