Abstract
BackgroundPeriprosthetic joint infection (PJI) is one of the most challenging complications of total joint arthroplasty (TJI). An early and accurate diagnosis of PJI is associated with better treatment outcomes. However, whether the platelet-related markers and globulin-related markers can be used to assist the diagnosis of PJI remains elusive.MethodsA total of 206 patients who underwent revision hip or knee arthroplasty in our institution were divided into two groups: 79 patients in PJI group and 127 patients in aseptic failure group. The levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet-related markers including platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT) and PLT to MPV ratio (PMR) and globulin-related markers such as globulin (GLB), albumin to globulin ratio (AGR) and PLT to AGR ratio were compared. The diagnostic value was measured using area under the curve (AUC) after constructing receiver operating characteristic (ROC) curves. The potential of each marker for determining the timing of second-staged reimplantation was also evaluated.ResultsSignificantly increased levels of ESR, CRP, PLT, PCT, PMR, GLB and PLT to AGR ratio were identified in PJI group, while decreased levels of MPV and AGR were also found. The diagnostic values of all platelet-related markers and GLB were considered as fair, and good diagnostic values of AGR and PLT to AGR ratio were found, which were comparable to those of ESR and CRP. The levels of GLB and AGR can also be used to predict negative culture result and the timing of second-stage reimplantation.ConclusionsGlobulin and albumin to globulin ratio were found to have good diagnostic values for PJI, and they can precisely predict the culture results and persistent infection.
Highlights
Periprosthetic joint infection (PJI) and aseptic failure (AF) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) are two major causes of theShang et al Journal of Orthopaedic Surgery and Research (2022) 17:12 swelling and elevated levels of inflammatory markers are presented in both AF and PJI patients
The laboratory test was examined on the day of admission, and we recorded platelet count (PLT), mean platelet volume (MPV), PCT, ALB, GLB and albumin to globulin ratio (AGR), as well as the perioperative results of pathogen culture
More knees were affected in PJI group than in AF group (Table 1)
Summary
Periprosthetic joint infection (PJI) and aseptic failure (AF) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) are two major causes of theShang et al Journal of Orthopaedic Surgery and Research (2022) 17:12 swelling and elevated levels of inflammatory markers are presented in both AF and PJI patients. A series of studies, including our previous study with the same series of patients, have demonstrated the diagnostic value of plasma fibrinogen for PJI is equivalent to that of CRP or erythrocyte sedimentation rate (ESR) and is far better than that of D-Dimer [8,9,10,11]. These findings further promote the potential roles of the fibrinolytic markers in the diagnosis of PJI. Whether the platelet-related markers and globulin-related markers can be used to assist the diagnosis of PJI remains elusive
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