Sweeney BM, Sadhwani S, Edwards T, Kelly M. Value of “true” leukocytosis formula in determining total knee arthroplasty prosthetic joint infection in the community hospital setting. World J Orthop 2026; 17(2): 113667 [DOI: 10.5312/wjo.v17.i2.113667]
Corresponding Author of This Article
Brendan M Sweeney, Department of Orthopedic Surgery, University of Pittsburgh Medical Center of Central PA, 4300 Londonderry Road, Harrisburg, PA 17109, United States. sweeneybm4@upmc.edu
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Orthopedics
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 18, 2026 (publication date) through Feb 4, 2026
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Publication Name
World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sweeney BM, Sadhwani S, Edwards T, Kelly M. Value of “true” leukocytosis formula in determining total knee arthroplasty prosthetic joint infection in the community hospital setting. World J Orthop 2026; 17(2): 113667 [DOI: 10.5312/wjo.v17.i2.113667]
World J Orthop. Feb 18, 2026; 17(2): 113667 Published online Feb 18, 2026. doi: 10.5312/wjo.v17.i2.113667
Value of “true” leukocytosis formula in determining total knee arthroplasty prosthetic joint infection in the community hospital setting
Brendan M Sweeney, Shaan Sadhwani, Timothy Edwards, Matthew Kelly
Brendan M Sweeney, Shaan Sadhwani, Timothy Edwards, Department of Orthopedic Surgery, University of Pittsburgh Medical Center of Central PA, Harrisburg, PA 17109, United States
Matthew Kelly, Department of Orthopedic Surgery, Orthopedic Institute of PA, Harrisburg, PA 17109, United States
Co-corresponding authors: Brendan M Sweeney and Shaan Sadhwani.
Author contributions: Sweeney BM designed the research study; Sweeney BM, Edwards T performed data collection; Sadhwani S and Edwards T performed data analysis; Sweeney BM, Sadhwani S, Edwards T, and Kelly M performed manuscript editing and writing; Sweeney BM and Sadhwani S contributed equally to this manuscript as co-corresponding authors. All authors have read and approved the final manuscript.
Institutional review board statement: This study was performed under the guidance of University of Pittsburgh Medical Center of Central PA Institutional Review Board (approval No. 23E002) and certificate of this will be available upon request.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sweeneybm4@upmc.edu. All data obtained in accordance with our institutional review board and all data has been anonymized. No additional data available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brendan M Sweeney, Department of Orthopedic Surgery, University of Pittsburgh Medical Center of Central PA, 4300 Londonderry Road, Harrisburg, PA 17109, United States. sweeneybm4@upmc.edu
Received: September 1, 2025 Revised: September 21, 2025 Accepted: December 4, 2025 Published online: February 18, 2026 Processing time: 156 Days and 1.9 Hours
Abstract
BACKGROUND
With the advent of recent point of care testing to evaluate for prosthetic joint infection (PJI) such as alpha-defensin and calprotectin, the diagnosis of PJI has reached a new paramount. The most widely accepted diagnostic criteria in the literature at this time is the international consensus meeting (ICM) score by Parvizi et al in 2018. One of the proposed limitations of the ICM criteria is determining if fluid analysis can be trusted for bloody joint aspirations. A proposed formula to correct red blood cells in aspirations was described in 2008 but has not been explored since then.
AIM
To determine if the “true leukocytosis” formula for prosthetic joint aspirations is useful in determining PJIs.
METHODS
Of 158 cases with International Classification of Diseases, 10th revision diagnoses of total knee arthroplasty PJIs from 2020-2021 from a single health system were reviewed and preoperative ICM scores were calculated. Inclusion criteria involved preoperative scores indicating infection, first time diagnoses, and culture positive infections. Culture positivity remained our gold standard for infection confirmation. We compared sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve for preoperative ICM score and corrected preoperative ICM score.
RESULTS
Of 81 cases met the inclusion criteria and had preoperative ICM scores calculated. Of the 81 cases that met inclusion criteria, no cases were found to have different preoperative ICM scores after applying the correction formula for “true leukocytosis” proposed by Ghanem et al in 2008.
CONCLUSION
Given the lack of variance in ICM score following the proposed correction formula, it appears that the proposed “true leukocytosis” formula is not a useful adjuvant in treatment decision making.
Core Tip: In this study we examine the usefulness of applying a correction formula for synovial fluid aspirations that contain red blood cells when determining prosthetic joint infections (PJI) using the international consensus meeting criteria. We compare the international consensus meeting criteria for PJI score both prior to and after applying the correction formula to evaluate if there would be any change to diagnosis in patients with concern for PJI.
