Serum Fibrinogen Test Performs Well for the Diagnosis of Periprosthetic Joint Infection |
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| Affiliation: | 1. University of Michigan Medical School, Ann Arbor, MI;2. Department of Surgery, University of Michigan, Ann Arbor MI;3. Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI;4. Department of Urology, University of Michigan, Ann Arbor, MI;5. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI;6. Michigan Surgical Quality Collaborative, Ann Arbor, MI;1. Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York City, NY;2. Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria;3. Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, NY;4. Department of Anesthesiology, Weill Cornell Medicine, New York, NY;5. Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York City, NY;6. Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY;7. Department of Health Policy and Research, Weill Cornell Medical College, New York, NY;1. Southmead Hospital, Bristol, United Kingdom;2. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, United Kingdom;3. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom |
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| Abstract: | BackgroundSerum fibrinogen (FIB) is an acute-phase glycoprotein in the infection response that may stop excessive bleeding. The purposes of this study are to determine the value of FIB that can be used to differentiate between periprosthetic joint infection (PJI) and aseptic loosening of the prosthesis, and to determine the clinical significance of FIB for analyzing infection outcomes after first-stage surgery.MethodsThis retrospective study included 90 patients undergoing total knee arthroplasty or total hip arthroplasty revision from January 2015 to August 2019. PJI was confirmed in 53 patients (group A), and the other 37 patients were diagnosed with aseptic loosening of the prosthesis (group B). Only 21 patients in group A documented the results for serum FIB, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) after spacer insertion, so the postoperative serological marker levels of the these patients were also assessed.ResultsThe FIB, CRP, and ESR levels were significantly higher in group A than in group B (P < .001). The area under the receiver operating characteristic curve was highest for FIB at 0.928. Analyses of FIB levels revealed a sensitivity of 79.25% and a specificity of 94.59%. FIB levels were significantly lower in patients with PJI after spacer insertion (P < .001).ConclusionFIB is an adequate test to aid in diagnosing PJI, and it is not inferior to CRP and ESR in distinguishing between PJI and aseptic loosening of the prosthesis. It is an especially useful tool in assessing infection outcomes after first-stage surgery. |
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| Keywords: | fibrinogen periprosthetic joint infection revision CRP ESR |
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