Leukocyte Esterase Strip Test: The Game-Changer in Early Detection and Prevention of Prosthetic Joint Infections
Abstract
Background: This study aimed to assess the diagnostic performance and preventive utility of the leukocyte esterase (LE) strip test in periprosthetic joint infections (PJIs) associated with hip and knee arthroplasty.
Methods: A comprehensive literature search was performed in PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2024. Search terms included “leukocyte esterase”, “strip test”, “prosthetic joint infection”, and “synovial fluid biomarkers”. Relevant studies were reviewed to evaluate LE testing methodologies and diagnostic accuracy.
Results: The LE strip test is a rapid and inexpensive bedside tool that offers results within minutes. It demonstrates high specificity as a rule-out test preoperatively and reliable sensitivity for PJI confirmation postoperatively. The accuracy of the test is enhanced by sample centrifugation and glucose testing.
Conclusion: The LE strip test is a valuable tool for preoperative screening and postoperative diagnosis of PJI, especially when incorporated into comprehensive diagnostic algorithms.
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2. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302-45. doi: 10.1128/cmr.00111-13. [PubMed: 24696437]. [PubMed Central: PMC3993098].
3. Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am. 2011;93(24):2242-8. doi: 10.2106/jbjs.J.01413. [PubMed: 22258769].
4. McNally M, Sousa R, Wouthuyzen-Bakker M, Chen AF, Soriano A, Vogely HC, et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J. 2021;103-b(1):18-25. doi: 10.1302/0301- 620x.103b1.Bjj-2020-1381.R1. [PubMed: 33380199]. [PubMed Central: PMC7954183].
5. Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Combined measurement of synovial fluid α-Defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am. 2014;96(17):1439-45. doi: 10.2106/jbjs.M.01316. [PubMed: 25187582].
6. Wang C, Li R, Wang Q, Wang C. Synovial Fluid Leukocyte Esterase in the Diagnosis of Peri-Prosthetic Joint Infection: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). 2018;19(3):245-53. doi: 10.1089/sur.2017.192. [PubMed: 29099342].
7. Li R, Lu Q, Zhou YG, Chai W, Lu SB, Chen JY. Centrifugation May Change the Results of Leukocyte Esterase Strip Testing in the Diagnosis of Periprosthetic Joint Infection. J Arthroplasty. 2018;33(9):2981-5. doi: 10.1016/j.arth.2018.04.015. [PubMed: 29752029].
8. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF,et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309-14.e2. doi: 10.1016/j.arth.2018.02.078. [PubMed: 29551303].
9. Li R, Li X, Yu B, Li X, Song X, Li H, et al. Comparison of leukocyte esterase testing of synovial fluid with synovial histology for the diagnosis of periprosthetic joint infection. Med Sci Monit. 2017;23:4440-6. doi: 10.12659/msm.906705. [PubMed: 28912417]. [PubMed Central: PMC5612200].
10. Colvin OC, Kransdorf MJ, Roberts CC, Chivers FS, Lorans R, Beauchamp CP, et al. Leukocyte esterase analysis in the diagnosis of joint infection: can we make a diagnosis using a simple urine dipstick? Skeletal Radiol. 2015;44(5):673-7. doi: 10.1007/s00256-015-2097-5. [PubMed: 25626524].
11. Deirmengian CA, Liang L, Rosenberger JP, Joaquim TR, Gould MR, Citrano PA, et al. The leukocyte esterase test strip is a poor rule-out test for periprosthetic joint infection. J Arthroplasty. 2018;33(8):2571-4. doi: 10.1016/j.arth.2018.03.005. [PubMed: 29656969].
12. Haertlé M, Kolbeck L, Macke C, Graulich T, Stauß R, Omar M. Diagnostic accuracy for periprosthetic joint infection does not improve by a combined use of glucose and leukocyte esterase strip reading as diagnostic parameters. J Clin Med. 2022;11(11):2979. doi: 10.3390/jcm11112979. [PubMed: 35683369]. [PubMed Central: PMC9181009].
13. Zhang J, Gui B, Cheng F, Rong G, Tang Z, Shen C. Influence of inflammatory arthritis on leukocyte esterase strip results in the diagnosis of periprosthetic joint infection. J Orthop Surg Res. 2020;15(1),10. doi: 10.1186/s13018-019-1523-0.
14. Wyatt MC, Beswick AD, Kunutsor SK, Wilson MJ, Whitehouse MR, Blom AW. The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: A systematic review and meta- analysis. J Bone Joint Surg Am. 2016;98(12):992-1000. doi: 10.2106/jbjs.15.01142. [PubMed: 27307359]. [PubMed Central: PMC4901182].
15. De Vecchi E, Villa F, Bortolin M, Toscano M, Tacchini L, Romanò CL, et al. Leucocyte esterase, glucose and C-reactive protein in the diagnosis of prosthetic joint infections: a prospective study. Clin Microbiol Infect. 2016;22(6):555-60. doi: 10.1016/j.cmi.2016.03.020. [PubMed: 27040804].
16. Shahi A, Alvand A, Ghanem E, Restrepo C, Parvizi J. The leukocyte esterase test for periprosthetic joint infection is not affected by prior antibiotic administration. J Bone Joint Surg Am. 2019;101(8):739-44. doi: 10.2106/jbjs.18.00615.
[PubMed: 30994592].
17. Hassas Yeganeh M, Talaei M, Bazzaz AE, Rahmani K, Sinaei R, Fathi M, et al. Determination of diagnostic value (validity) leukocyte esterase (urine dipstick strip) in differentiating inflammatory arthritis from bacterial arthritis. Adv Rheumatol. 2020;60(1):11. doi: 10.1186/s42358-020-0115-3. [PubMed: 31992368].
18. Al-Jabri T, Ridha M, Wood MJ, Kayani B, Jayadev C, McCulloch RA, et al. An overview of the current diagnostic approach to periprosthetic joint infections. Orthop Rev (Pavia). 2024;16:120308. doi: 10.52965/001c.120308. [PubMed: 38957745]. [PubMed Central: PMC11218870].
19. Zheng QY, Zhang GQ. Application of leukocyte esterase strip test in the screening of periprosthetic joint infections and prospects of high-precision strips. Arthroplasty. 2020;2(1):34. doi: 10.1186/s42836-020-00053-5. [PubMed: 35236471]. [PubMed Central: PMC8796411].
20. Wasterlain AS, Goswami K, Ghasemi SA, Parvizi J. Diagnosis of periprosthetic infection: Recent developments. J Bone Joint Surg Am. 2020;102(15):1366-75. doi: 10.2106/jbjs.19.00598. [PubMed: 32769605].
21. Ting NT, Della Valle CJ. Diagnosis of periprosthetic joint infection-an algorithm-based approach. J Arthroplasty. 2017;32(7):2047-50. doi: 10.1016/j.arth.2017.02.070. [PubMed: 28343826].
22. Zheng QY,LiR,NiM,RenP,JiQB,SunJY,etal.WhatIsthe optimal timing for reading the leukocyte esterase strip for the diagnosis of periprosthetic joint infection? Clin Orthop Relat Res. 2021;479(6):1323-30. doi: 10.1097/corr.0000000000001609. [PubMed: 33492869]. [PubMed Central: PMC8133206].
23. Gautam VK, Saini R, Sharma S. Effectiveness of leucocyte esterase as a diagnostic test for acute septic arthritis. J Orthop Surg (Hong Kong). 2017;25(1):2309499016685019. doi: 10.1177/2309499016685019. [PubMed: 28134047].
24. Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J. 2013; 95-b(11):1450-2. doi: 10.1302/0301-620x.95b11.33135. [PubMed: 24151261].
25. Dragosloveanu S, Vulpe DE, Andrei CA, Nedelea DG, Garofil ND, Anghel C, et al. Predicting periprosthetic joint Infection: Evaluating supervised machine learning models for clinical application. J Orthop Translat. 2025;54:51-64. doi: 10.1016/j.jot.2025.06.016. [PubMed: 40703570]. [PubMed Central: PMC12284488].
2. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302-45. doi: 10.1128/cmr.00111-13. [PubMed: 24696437]. [PubMed Central: PMC3993098].
3. Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am. 2011;93(24):2242-8. doi: 10.2106/jbjs.J.01413. [PubMed: 22258769].
4. McNally M, Sousa R, Wouthuyzen-Bakker M, Chen AF, Soriano A, Vogely HC, et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J. 2021;103-b(1):18-25. doi: 10.1302/0301- 620x.103b1.Bjj-2020-1381.R1. [PubMed: 33380199]. [PubMed Central: PMC7954183].
5. Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Combined measurement of synovial fluid α-Defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am. 2014;96(17):1439-45. doi: 10.2106/jbjs.M.01316. [PubMed: 25187582].
6. Wang C, Li R, Wang Q, Wang C. Synovial Fluid Leukocyte Esterase in the Diagnosis of Peri-Prosthetic Joint Infection: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). 2018;19(3):245-53. doi: 10.1089/sur.2017.192. [PubMed: 29099342].
7. Li R, Lu Q, Zhou YG, Chai W, Lu SB, Chen JY. Centrifugation May Change the Results of Leukocyte Esterase Strip Testing in the Diagnosis of Periprosthetic Joint Infection. J Arthroplasty. 2018;33(9):2981-5. doi: 10.1016/j.arth.2018.04.015. [PubMed: 29752029].
8. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF,et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309-14.e2. doi: 10.1016/j.arth.2018.02.078. [PubMed: 29551303].
9. Li R, Li X, Yu B, Li X, Song X, Li H, et al. Comparison of leukocyte esterase testing of synovial fluid with synovial histology for the diagnosis of periprosthetic joint infection. Med Sci Monit. 2017;23:4440-6. doi: 10.12659/msm.906705. [PubMed: 28912417]. [PubMed Central: PMC5612200].
10. Colvin OC, Kransdorf MJ, Roberts CC, Chivers FS, Lorans R, Beauchamp CP, et al. Leukocyte esterase analysis in the diagnosis of joint infection: can we make a diagnosis using a simple urine dipstick? Skeletal Radiol. 2015;44(5):673-7. doi: 10.1007/s00256-015-2097-5. [PubMed: 25626524].
11. Deirmengian CA, Liang L, Rosenberger JP, Joaquim TR, Gould MR, Citrano PA, et al. The leukocyte esterase test strip is a poor rule-out test for periprosthetic joint infection. J Arthroplasty. 2018;33(8):2571-4. doi: 10.1016/j.arth.2018.03.005. [PubMed: 29656969].
12. Haertlé M, Kolbeck L, Macke C, Graulich T, Stauß R, Omar M. Diagnostic accuracy for periprosthetic joint infection does not improve by a combined use of glucose and leukocyte esterase strip reading as diagnostic parameters. J Clin Med. 2022;11(11):2979. doi: 10.3390/jcm11112979. [PubMed: 35683369]. [PubMed Central: PMC9181009].
13. Zhang J, Gui B, Cheng F, Rong G, Tang Z, Shen C. Influence of inflammatory arthritis on leukocyte esterase strip results in the diagnosis of periprosthetic joint infection. J Orthop Surg Res. 2020;15(1),10. doi: 10.1186/s13018-019-1523-0.
14. Wyatt MC, Beswick AD, Kunutsor SK, Wilson MJ, Whitehouse MR, Blom AW. The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: A systematic review and meta- analysis. J Bone Joint Surg Am. 2016;98(12):992-1000. doi: 10.2106/jbjs.15.01142. [PubMed: 27307359]. [PubMed Central: PMC4901182].
15. De Vecchi E, Villa F, Bortolin M, Toscano M, Tacchini L, Romanò CL, et al. Leucocyte esterase, glucose and C-reactive protein in the diagnosis of prosthetic joint infections: a prospective study. Clin Microbiol Infect. 2016;22(6):555-60. doi: 10.1016/j.cmi.2016.03.020. [PubMed: 27040804].
16. Shahi A, Alvand A, Ghanem E, Restrepo C, Parvizi J. The leukocyte esterase test for periprosthetic joint infection is not affected by prior antibiotic administration. J Bone Joint Surg Am. 2019;101(8):739-44. doi: 10.2106/jbjs.18.00615.
[PubMed: 30994592].
17. Hassas Yeganeh M, Talaei M, Bazzaz AE, Rahmani K, Sinaei R, Fathi M, et al. Determination of diagnostic value (validity) leukocyte esterase (urine dipstick strip) in differentiating inflammatory arthritis from bacterial arthritis. Adv Rheumatol. 2020;60(1):11. doi: 10.1186/s42358-020-0115-3. [PubMed: 31992368].
18. Al-Jabri T, Ridha M, Wood MJ, Kayani B, Jayadev C, McCulloch RA, et al. An overview of the current diagnostic approach to periprosthetic joint infections. Orthop Rev (Pavia). 2024;16:120308. doi: 10.52965/001c.120308. [PubMed: 38957745]. [PubMed Central: PMC11218870].
19. Zheng QY, Zhang GQ. Application of leukocyte esterase strip test in the screening of periprosthetic joint infections and prospects of high-precision strips. Arthroplasty. 2020;2(1):34. doi: 10.1186/s42836-020-00053-5. [PubMed: 35236471]. [PubMed Central: PMC8796411].
20. Wasterlain AS, Goswami K, Ghasemi SA, Parvizi J. Diagnosis of periprosthetic infection: Recent developments. J Bone Joint Surg Am. 2020;102(15):1366-75. doi: 10.2106/jbjs.19.00598. [PubMed: 32769605].
21. Ting NT, Della Valle CJ. Diagnosis of periprosthetic joint infection-an algorithm-based approach. J Arthroplasty. 2017;32(7):2047-50. doi: 10.1016/j.arth.2017.02.070. [PubMed: 28343826].
22. Zheng QY,LiR,NiM,RenP,JiQB,SunJY,etal.WhatIsthe optimal timing for reading the leukocyte esterase strip for the diagnosis of periprosthetic joint infection? Clin Orthop Relat Res. 2021;479(6):1323-30. doi: 10.1097/corr.0000000000001609. [PubMed: 33492869]. [PubMed Central: PMC8133206].
23. Gautam VK, Saini R, Sharma S. Effectiveness of leucocyte esterase as a diagnostic test for acute septic arthritis. J Orthop Surg (Hong Kong). 2017;25(1):2309499016685019. doi: 10.1177/2309499016685019. [PubMed: 28134047].
24. Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J. 2013; 95-b(11):1450-2. doi: 10.1302/0301-620x.95b11.33135. [PubMed: 24151261].
25. Dragosloveanu S, Vulpe DE, Andrei CA, Nedelea DG, Garofil ND, Anghel C, et al. Predicting periprosthetic joint Infection: Evaluating supervised machine learning models for clinical application. J Orthop Translat. 2025;54:51-64. doi: 10.1016/j.jot.2025.06.016. [PubMed: 40703570]. [PubMed Central: PMC12284488].
| Files | ||
| Issue | Vol 12 No 1 (2026) | |
| Section | Review Article | |
| Keywords | ||
| Total Hip Arthroplasty Knee Arthroplasty Leukocytes Esterase | ||
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How to Cite
1.
Ayati Firoozabadi M, Rezaee H, Salkhori O, Mortazavi SMJ. Leukocyte Esterase Strip Test: The Game-Changer in Early Detection and Prevention of Prosthetic Joint Infections. J Orthop Spine Trauma. 2026;12(1):5-8.
