Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Mar 15;32(6):271-278.
doi: 10.5435/JAAOS-D-23-00600. Epub 2023 Dec 20.

Neutrophil to Lymphocyte Ratio as an Indicator of Periprosthetic Joint Infection: A Retrospective Cohort Study

Leah Nairn  1 , Surabhi Sivaratnam, Kamal Bali, Thomas J Wood
Affiliations
Review

Neutrophil to Lymphocyte Ratio as an Indicator of Periprosthetic Joint Infection: A Retrospective Cohort Study

Leah Nairn et al. J Am Acad Orthop Surg. .

Abstract

Introduction: Periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) is a serious complication posing notable clinical implications for patients and substantial economic burdens. Neutrophil to lymphocyte ratio (NLR) is an emerging biomarker of inflammation, which may better predict PJI. The objective of this review was to evaluate NLR changes in patients with confirmed PJI, to compare NLR between an aseptic revision and a revision for PJI, and to establish whether an NLR of 2.45 is an appropriate cutoff for predicting infection.

Methods: A retrospective review of patients who underwent revision TJA for PJI at a single center between January 1, 2005, and December 31, 2018, was performed and compared with an aseptic cohort who underwent aseptic revision TJA. NLR was calculated from complete blood counts performed at index surgery and at the time of revision surgery. Receiver operating characteristic curves were analyzed, along with sensitivity, specificity, and positive and negative likelihood ratios.

Results: There were 89 patients included in each cohort. Mean NLR in patients who underwent revision for PJI was 2.85 (± 1.27) at the time of index surgery and 6.89 (± 6.64) at the time of revision surgery ( P = 0.017). Mean NLR in patients undergoing revision for PJI (6.89) was significantly higher than aseptic revisions (3.17; P < 0.001).

Discussion: In patients who underwent revision surgery for PJI, NLR was markedly elevated at time of revision compared with the time of index surgery. Because it is a cost-effective and readily available test, these findings suggest that NLR may be a useful triage test in the diagnosis of PJI.

Level of evidence: Level III Diagnostic Study.

PubMed Disclaimer

References

    1. Premkumar A, Kolin DA, Farley KX, et al.: Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty 2021;36:1484-1489.e3.
    1. Kamath AF, Ong KL, Lau E, et al.: Quantifying the burden of revision total joint arthroplasty for periprosthetic infection. J Arthroplasty 2015;30:1492-1497.
    1. Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA: The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 2014;29:929-932.
    1. Kurtz SM, Lau EC, Son M-S, Chang ET, Zimmerli W, Parvizi J: Are we winning or losing the battle with periprosthetic joint infection: Trends in periprosthetic joint infection and mortality risk for the medicare population. J Arthroplasty 2018;33:3238-3245.
    1. Parvizi J, Zmistowski B, Berbari EF, et al.: New definition for periprosthetic joint infection: From the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res 2011;469:2992-2994.

MeSH terms