Diagnostic Utility and Thresholds for Commonly Obtained Serum and Synovial Markers Prior to Reimplantation in Periprosthetic Joint Infection |
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| Institution: | 1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana;2. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan;1. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China;2. Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China;3. Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China;4. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China;5. Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China;6. China Standard Medical Information Research Center, Shenzhen, Guangdong, China;7. Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China;1. Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana;2. LSUHSC Department of Orthopedic Surgery, New Orleans, Louisiana;3. Ochsner Sports Medicine Institute, Jefferson, Louisiana;1. Department of Orthopaedic Surgery, Corewell Health/Michigan State University, Grand Rapids, Michigan;2. The CORE Institute, Novi, Michigan;3. Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, Michigan;1. Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia;2. Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia;3. Fundación Valle del Lili, Departamento de Ortopedia y Traumatología, Cali, Colombia |
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| Abstract: | BackgroundAccurate diagnosis of persistent periprosthetic joint infection (PJI) during 2-stage exchange remains a challenge. This study evaluated the diagnostic performance and thresholds of several commonly obtained serum and synovial markers to better guide reimplantation timing.MethodsThis was a retrospective review of 249 patients who underwent 2-stage exchange with antibiotic spacers for PJI. Serum and synovial markers analyzed included white blood cell (WBC) count, polymorphonuclear percentage (PMN%), neutrophil-to-lymphocyte ratio (NLR), and absolute neutrophil count (ANC). Serum markers analyzed were erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), as well as percentage change in ESR and CRP from initial diagnosis to reimplantation. Area under the curve (AUC) analyses were performed to determine diagnostic accuracy of detecting PJI.ResultsIn TKAs, synovial ANC and WBC had the highest AUCs (0.76), with thresholds of 2,952 and 3,800 cells/μL, respectively. The next best marker was serum CRP (0.73) with a threshold of 5.2 mg/dL. In THAs, serum CRP had the highest AUC (0.84) with a threshold of 4.3 mg/dL, followed by synovial PMN% (0.80) with a threshold of 77%. Percentage change in serum ESR or CRP provided low diagnostic value overall.ConclusionRegarding serum markers, CRP consistently performed well in detecting persistent PJI in patients with antibiotic spacers. Absolute values of serum CRP and ESR had better diagnostic value than trends for guiding reimplantation timing. Diagnostic performance differed with joint type; however, synovial markers outperformed serum counterparts. No marker alone can be utilized to diagnose residual PJI in these patients, and further work is needed in this domain. |
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| Keywords: | reimplantation periprosthetic joint infection markers diagnosis thresholds |
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