Abstract
BackgroundEarly detection followed by prompt intervention is essential for the treatment of periprosthetic joint infection (PJI). D-dimer, a fibrin degradation product, characteristically changes rapidly during early postoperative period and has a short half-life. The aim of this prospective study was to measure postoperative change of D-dimer level after joint arthroplasty in conjunction with ESR and CRP.MethodsESR, CRP, and D-dimer levels were measured on the day before surgery, postoperative days 1, 2, 3, and 5 and weeks 2 and 6 in 65 patients who underwent elective primary total hip arthroplasty (38 hips in 38 patients) or total knee arthroplasty (27 knees in 27 patients). We compared perioperative changes of the three biomarkers.ResultsESR level was elevated from postoperative day 1 and reached a peak level of 45 mm/h at postoperative day 5. The elevation persisted until postoperative week 6. CRP level was elevated from postoperative day 1 and reached a peak level of 10 mg/dl between postoperative day 2 and day 3. The CRP level was decreased to the normal level around postoperative week 2. D-dimer level was sharply elevated and peaked to 4.5 μg/dl at postoperative day 1. At postoperative day 2, it decreased to baseline level. After then, it slowly elevated again and reached a second peak at postoperative week 2.ConclusionD-dimer showed a more rapid rise and fall than ESR and CRP in very early postoperative period. The D-dimer test might be effective in early detection of PJI, if combined with levels of ESR and CRP. The postoperative change of D-dimer in our study can serve as a baseline for early diagnosis of PJI.
Highlights
Detection followed by prompt intervention is essential for the treatment of periprosthetic joint infection (PJI)
In C-reactive protein (CRP), postoperative 2-week value showed a statistically significant difference between groups and higher value was observed in the total knee arthroplasty (TKA) group
In D-dimer, values showed a statistically significant difference between groups at the preoperative value and postoperative day 5 and they were consistently high in the total hip arthroplasty (THA) group
Summary
Detection followed by prompt intervention is essential for the treatment of periprosthetic joint infection (PJI). D-dimer, a fibrin degradation product, characteristically changes rapidly during early postoperative period and has a short half-life. The aim of this prospective study was to measure postoperative change of D-dimer level after joint arthroplasty in conjunction with ESR and CRP. It characteristically shows sharp increase up to double levels and decrease to the baseline level within a short time during early postoperative period. After it shows second peak after maintaining at the steady level for a while [12]. ESR and CRP had a sensitivity of 73 and 79% and a specificity of 78 and 80%, respectively [13]
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