Neutrophils are frequently found in the cytological picture of synovial fluid in several joint pathologies, and a higher proportion of them can even wrongly indicate these cases as purulent inflammation. For reliable differentiation between purulent and non-purulent cases, we use the cytological energy analysis of the synovial fluid. Using this method, we examined 350 knee joint synovial fluid samples. Overall, we found that the percentage of neutrophils ranged between 20.0% and 50.0% in 44 (12.6%) cases and was above 50.0% in 231 (66.0%) cases. In the same group, only 85 (24.3%) highly anaerobic synovial fluid samples were evaluated as purulent inflammation, and another 17 (4.9%) cases were evaluated as very likely purulent inflammation. Further, we quantified the immediate risk of purulent inflammation using the "purulent score" (PS). Of the total of 350 samples, 103 (29.4%) cases were classified as having a very high risk of purulent inflammation (PS = 4), 53 (15.1%) cases were classified as having a significant risk of purulent inflammation (PS = 3), 17 (4.9%) cases were classified as having a moderate risk of purulent inflammation (PS = 2), and 75 (21.4%) cases were classified as having no immediate risk of purulent inflammation (PS = 1). Based on our results and analyses, the cytological energy analysis of synovial fluid is an effective method that can be used to detect and specify joint inflammation and the risk of septic arthritis development.

Department of Biomedicine and Laboratory Diagnostics Faculty of Health Studies Jan Evangelista Purkinje University and Masaryk Hospital 401 13 Usti nad Labem Czech Republic

Department of Central Laboratories Hospital Teplice 415 29 Teplice Czech Republic

Department of Clinical Immunology and Allergology Faculty of Medicine and University Hospital Charles University Prague 500 03 Hradec Kralove Czech Republic

Department of Orthopaedic Surgery Faculty of Medicine and University Hospital Charles University Prague 500 03 Hradec Kralove Czech Republic

Department of Orthopaedics Faculty of Health Studies Jan Evangelista Purkinje University and Masaryk Hospital 401 13 Usti nad Labem Czech Republic

Department of Orthopaedics Regional Hospital 360 01 Karlovy Vary Czech Republic

Faculty of Health Studies Jan Evangelista Purkinje University 400 96 Usti nad Labem Czech Republic

Laboratory for Cerebrospinal Fluid Neuroimmunology Pathology and Special Diagnostics Topelex 190 00 Prague Czech Republic

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