Abstract
BackgroundThe preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing re-revision arthroplasty is crucial, so we evaluated whether plasma levels of D-dimer and fibrin degradation product (FDP) could aid such diagnosis.MethodsWe retrospectively analyzed data on patients who underwent re-revision hip or knee arthroplasty at our institute during 2008–2020. Patients were stratified into those who experienced PJI or not, based on 2013 International Consensus Meeting Criteria. Plasma levels of D-dimer and FDP as well as levels of the traditional inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and interleukin-6 were compared between the groups. The ability of these biomarkers to diagnose PJI was assessed based on the area under the receiver operating characteristic (AUC) curve, for which predictive cut-offs were optimized based on the Youden index.ResultsBased on a cut-off of 0.80 mg/L, D-dimer gave an AUC of 0.595, high sensitivity of 85.7% but poor specificity of 47.8%. Based on a cut-off of 2.80 mg/L, FDP gave an AUC of 0.550, poor sensitivity of 56.5% and poor specificity of 52.9%. CRP, ESR and interleukin-6 showed much better diagnostic ability, with AUCs > 0.82. The combination of CRP and interleukin-6 gave an AUC of 0.877, high sensitivity of 91.7% and acceptable specificity of 78.3%.ConclusionsPlasma levels of D-dimer and FDP may be inappropriate for diagnosing PJI in patients undergoing re-revision arthroplasty, whereas the combination of serum CRP and interleukin-6 may be effective.
Highlights
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective treatments for end-stage hip and knee diseases
We initially enrolled 99 patients but excluded those who underwent reimplantation surgery (n = 15), who were diagnosed with periprosthetic fracture or dislocation (n = 16), and those who were followed up for less than one year (n = 3)
Serum levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were assayed in all patients, while levels of interleukin-6 were assayed in
Summary
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective treatments for end-stage hip and knee diseases. As the number of primary arthroplasties increase, so does the number of revision arthroplasties [3], and a substantial proportion of patients undergoing revision arthroplasty are young [4, 5]. In the US alone, as many as 268,200 revision knee arthroplasties and 97,700 revision hip arthroplasties are expected to be performed in 2030 [6]. This constitutes a substantial medical and economic burden on society and the healthcare system [7]. The preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing re-revision arthroplasty is crucial, so we evaluated whether plasma levels of D-dimer and fibrin degradation product (FDP) could aid such diagnosis
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