A Retrospective Review of Native Septic Arthritis in Patients: Can We Diagnose Based on Laboratory Values?

Introduction The accurate diagnosis of acute septic arthritis is essential to initiating appropriate treatment and minimizing potential cartilage damage. A synovial fluid cell count of 50,000 cells/mm has been used as a diagnostic cutoff for acute septic arthritis, although data supporting this is lacking. The purpose of this study was to assess the efficacy of synovial cell counts to predict septic arthritis in patients with symptomatic native joints. Methods A retrospective review was performed of patients who were evaluated for septic arthritis at a single institution with the use of synovial fluid analysis and adjunctive lab tests. Exclusion criteria included history of a total joint arthroplasty of the affected joint or immunocompromised state. A true infection was considered on the basis of positive or negative synovial aspirate cultures. We evaluated the synovial cell count, synovial polymorphonuclear cell percentile (% neutrophils), serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in order to determine their association and predictive power in a true infection. Results Of the 65 patients included in the study, 40 (61.5%) had a positive culture for septic arthritis and 25 (38.5%) had negative cultures. Patients with positive cultures had a larger median % neutrophils than patients with negative cultures (median: 93 vs. median: 86, P=0.041). They also tended to have higher serum CRP levels compared to negative culture patients (median: 142.30 vs. 34.20, P=0.051). No outcomes were independently highly effective in discriminating between patient groups (area under the curve (AUC) ≤ 0.67). There was no significant difference between the synovial cell counts in patients with culture positive septic arthritis and patients with negative cultures (median: 32435 vs 35385, P = 0.94).  Conclusion Patients with culture proven septic arthritis had larger % neutrophils. However, there were no other statistically significant differences between patient groups regarding ESR, CRP, WBC, or cell count aspiration at the time of diagnosis. No synovial cell count level was highly effective in discriminating patients with a positive culture for septic arthritis from patients with negative cultures.