Synovial Fluid Leukocyte Count and Differential Are Poor Standalone Rule-in Tests for Periprosthetic Joint Infection: Results of a Methodological Audit and Reanalysis of the 2025 Meta-analysis Underpinning the Unified Periprosthetic Joint Infection Criteria
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The authors aimed to evaluate the methodological rigor of the 2025 meta-analysis supporting the Unified Periprosthetic Joint Infection (PJI) Criteria and to determine whether synovial fluid leukocyte count and polymorphonuclear cell percentage are reliable standalone tests for diagnosing PJI. Their findings revealed critical limitations in the original meta-analysis, including data integrity issues and high heterogeneity, leading to the conclusion that these tests do not provide sufficient or generalizable rule-in performance for PJI, with low positive predictive values. Consequently, the authors recommend against using these thresholds as standalone criteria and advocate for a multimodal diagnostic approach.
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