Abstract
BackgroundSince a “gold-standard” is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection.MethodsBetween August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT and SF-PCT levels were measured using standard quantitative PCT enzyme immunoassays.ResultsTwenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p < 0.001) higher in the PJI group than those in the aseptic group (PJI 0.05 ± 0.21 ng/mL (0.0–1.03) vs. aseptic 0.02 ± 0.03 ng/mL (0.0–0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p < 0.001) than those of PJI group (PJI 2.7 ± 1.4 ng/mL (0.53–9.7) vs. aseptic 8.7 ± 2.5 ng/mL (0.25–87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specificity of 91.0%.SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specificity of 52.0%.ConclusionS-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Highlights
Since a “gold-standard” is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery
We evaluate the effectiveness of Synovial fluid (SF)-PCT for diagnosis of PJI
Patients From July 2018 to June 2019, 78 patients introduced themselves with persisting pain after hip, knee and shoulder arthroplasty in the consultation hour
Summary
Since a “gold-standard” is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Periprosthetic joint infection (PJI) is a severe complication after total joint arthroplasty. It is one of most common reasons for revision surgery in arthroplasty [1]. Microbiological diagnostic is occasionally false negative or positive [5] Conventional serum biomarkers such as white cell count (WCC) and C-reactive protein (CRP) have limited diagnostic accuracy [6, 7]. There is no “gold standard” for definite diagnosis of PJI [10]
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