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Abstract
PurposeThe purpose of this study was to investigate the role of synovial fluid interleukin (IL)-1β in diagnosing chronic periprosthetic joint infection (PJI) and to identify the optimal threshold of synovial fluid IL-1β for differentiating chronic PJI from aseptic failure after knee and hip arthroplasties.MethodsBetween January 2019 and December 2019, we prospectively included patients scheduled to have a revision surgery for chronic PJI or aseptic failure after total joint arthroplasty. Then, synovial IL-1β was additionally measured along with routine preoperative diagnostic serum and synovial biomarkers. The receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker to determine diagnostic efficacy.ResultsOf the 93 patients included, their demographic data were not found to be statistically significant. The median synovial IL-1β levels were significantly higher in the chronic PJI group than in the aseptic group (894.73 pg/mL vs. 34.49 pg/mL, P<0.01). The AUC for synovial fluid IL-1β was 0.991, which was higher than serum ESR (0.627) and CRP (0.712). The optimal threshold value for detecting chronic PJI of synovial IL-1β was 312.7 pg/mL, with a sensitivity of 97.3% and a specificity of 94.64%. And the combined measurement of synovial fluid IL-1β and synovial fluid PMN% can led to a specificity of 1, and a negative predictive value (NPV) of 1.ConclusionsThe present study demonstrated that synovial fluid IL-1β is a valuable biomarker for detection of chronic PJI. The combination of synovial fluid IL-1β and PMN% led to an improvement in specificity compared with evaluation of each single index.Trial registrationThis study was prospectively registered on the Chinese Clinical Trial Registry (a non-profit organization, established according to both the WHO International Clinical Trials Register Platform Standard and Ottawa Group Standard), and the registering number was ChiCTR1800020440. Registered on December 29, 2018.
Highlights
One of the most challenging complications of total joint arthroplasty (TJA) is periprosthetic joint infection (PJI), which has major health and economic consequences [1]
The study included a total of 93 patients, of whom 37 (39.8%) patients with infection were assigned to the chronic PJI group and 56 (60.2%) with aseptic loosening of the implant were assigned to the aseptic prosthetic failure group
Median serum erythrocyte sedimentation rate (ESR) was significantly higher in the chronic PJI group compared with the aseptic prosthetic failure group (35.00 mm/h vs. 21.00 mm/h, P=0.04), as were median serum C-reactive protein (CRP) (19.00 mg/L vs. 13.18 mg/L; P
Summary
One of the most challenging complications of total joint arthroplasty (TJA) is periprosthetic joint infection (PJI), which has major health and economic consequences [1]. PJI is the leading reason for revision after total knee arthroplasty and the fourth most common reason for consultation after total hip arthroplasty [2, 3]. The distinction between PJI and aseptic prosthetic failure is critical, because the treatments for these two conditions are fundamentally different. Many cases of chronic PJI are clinically difficult to distinguish from aseptic prosthetic failure because the typical signs may be completely absent. Patients often present with chronic pain or only slight clinical symptoms. Accurate diagnosis of chronic PJI plays a very important role in the overall treatment process
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