Orthopedic Infections Research Articles

Bacteriophage therapy for bone and joint infections.

Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant infections could cause ten million deaths each year. In orthopaedics, many patients undergoing surgery suffer from complications resulting from implant-associated infection. In these circumstances secondary surgery is usually required and chronic and/or relapsing disease may ensue. The development of effective treatments for antibiotic-resistant infections is needed. Recent evidence shows that bacteriophage (phages; viruses that infect bacteria) therapy may represent a viable and successful solution. In this review, a brief description of bone and joint infection and the nature of bacteriophages is presented, as well as a summary of our current knowledge on the use of bacteriophages in the treatment of bacterial infections. We present contemporary published in vitro and in vivo data as well as data from clinical trials, as they relate to bone and joint infections. We discuss the potential use of bacteriophage therapy in orthopaedic infections. This area of research is beginning to reveal successful results, but mostly in nonorthopaedic fields. We believe that bacteriophage therapy has potential therapeutic value for implant-associated infections in orthopaedics.Cite this article: Bone Joint J 2021;103-B(2):234–244.

The yield of sonication fluid culture for presumed aseptic loosening of orthopedic devices: a meta-analysis

Sonication fluid culture is routinely conducted in patients with suspected orthopedic devicerelated infection (ORI). However, its value in the assessment of orthopedic devices that have explanted because of presumed aseptic loosening is still debatable. A meta-analysis was conducted to estimate the yield of sonication fluid culture in detecting the presence of microorganisms in orthopedic devices with presumed aseptic loosening, and to summarize the clinical characteristics and outcomes of these patients. A meta-analysis was performed of peer-reviewed publications detailing the characteristics of patients whose orthopedic devices were explanted for presumed aseptic loosening and who underwent subsequent sonication fluid culture. Diagnostic data were extracted and pooled to estimate the yield of sonication fluid culture for detecting the presence of microorganisms with 95% confidence intervals (CI). Eight studies involving 421 patients were included in the meta-analysis analysis. The pooled results showed that sonication fluid culture had a yield of approximately 30% (95% CI: 20-41%) for identifying the presence of microorganisms in presumed aseptic loosening of orthopedic devices; this yield was higher than that of intraoperative tissue culture (22%, 95% CI: 8-41%) and aspirated fluid culture (13%, 95% CI: 7-21%). Sonication and vortexing for ≤5 min had a detection rate of 49% (95% CI: 43-55%), which exceeded that of >5 min. Coagulase-negative Streptococcus accounted for 74% (95% CI: 51-92%) of the isolated microorganisms. However, patients with positive microbiological results of sonication fluid culture and those with negative results showed similar outcomes after revision surgery. Colonization of low-virulent microorganisms may exist in a considerable number of patients with clinically presumed aseptic loosening of orthopedic devices. When this occurs, sonication (1-5 min at 40 kHz) of fluid culture could act as a sensitive diagnostic tool. However, the question of whether sonication fluid culture should be integrated into the routine treatment of loosened orthopedic devices requires further investigation.

An update about molecular biology techniques to detect orthopaedic implant-related infections.

Despite different criteria to diagnose a prosthetic joint infection (PJI), aetiological diagnosis of the causing microorganism remains essential to guide treatment.Molecular-biology-based PJI diagnosis is progressing (faster, higher specificity) in different techniques, from the experimental laboratory into clinical use.Multiplex polymerase chain reaction techniques (custom-made or commercial) provide satisfactory results in clinical series of cases, with specificity close to 100% and sensitivity over 70–80%.Next-generation metagenomics may increase sensitivity while maintaining high specificity.Molecular biology techniques may represent, in the next five years, a significant transformation of the currently available microbiological diagnosis in PJI.Cite this article: EFORT Open Rev 2021;6:93-100. DOI: 10.1302/2058-5241.6.200118

Bacteriophage-Delivering Hydrogels: Current Progress in Combating Antibiotic Resistant Bacterial Infection

Antibiotic resistance remains as an unresolved global challenge in the health care system, posing serious threats to global health. As an alternative to antibiotics, bacteriophage (phage) therapy is rising as a key to combating antibiotic-resistant bacterial infections. In order to deliver a phage to the site of infection, hydrogels have been formulated to incorporate phages, owing to its favorable characteristics in delivering biological molecules. This paper reviews the formulation of phage-delivering hydrogels for orthopedic implant-associated bone infection, catheter-associated urinary tract infection and trauma-associated wound infection, with a focus on the preparation methods, stability, efficacy and safety of hydrogels as phage carriers.

Preparation of Vanillic Acid-Loaded Core-Shell Gold Nanospheres/Mesoporous Silica Nanoparticles for the Treatment of Orthopedic Infection.

Orthopedic infection is a serious complication in surgeries and remains a great challenge in clinics. Here, the natural antimicrobial compound vanillic acid-loaded gold nanospheres/mesoporous silica nanoparticles (VA@Au-MSNs) were fabricated for chemo-photothermal synergistic therapy to orthopedic infections. The shape and morphology of Au-MSN and VA@Au-MSN were observed by scanning electron microscopy and transmission electron microscopy. The properties of VA@Au-MSN or related components were characterized by dynamic light scattering, thermogravimetric analysis, Brunauer–Emmett–Teller (BET) analysis, and photothermal analysis. Vanillic acid released from VA@Au-MSN was detected in phosphate-buffered saline. A cytotoxicity test and an antibacterial assessment were performed to explore the biosafety and antibacterial activity of VA@Au-MSN, respectively. The results showed that Au-MSN possessed a high BET surface area (458 m2/g). After loading vanillic acid, the BET surface area reduced to 72 m2/g. The loading efficiency of Au-MSN was 18.56%. Under 808 nm laser irradiation, the temperature at the wound site injected with the Au-MSN solution in the mouse increased from 24 to 60 °C within about 12 s. Also, the high temperature could promote the release of vanillic acid from VA@Au-MSN. Additionally, VA@Au-MSN has no obvious cytotoxicity to MC3T3-E1 cells, but the generated local hyperthermia and the VA released from VA@Au-MSN had excellent antibacterial activity against Staphylococcus aureus in a synergistic way. In conclusion, the VA@Au-MSN with biosafety and excellent antibacterial performance might be applied for the treatment of orthopedic infection.

Hybrid ZnO/chitosan antimicrobial coatings with enhanced mechanical and bioactive properties for titanium implants

A biocomposite coating comprising chitosan and ZnO deposited on a porous Ti oxide is developed to avoid orthopedic and dental implant-related infections. The coating comprised of an inner layer of nanoporous TiO2 and the outer layer of the chitosan matrix with ZnO nanoparticles. Microbiological tests show that chitosan coating is effective against Escherichia coli (E. coli), however, its ability to inhibit bacterial adhesion is very limited. A 1.2-fold increase in the antibacterial activity of chitosan/ZnO coating against E. coli was detected as compared to the chitosan coating alone, and the chitosan/ZnO efficiently inhibited biofilm formation. In addition, the chitosan/ZnO coating exhibited improved bioactivity compared to the chitosan coating. The improvement in antibacterial properties and bioactivity of the chitosan/ZnO coating is attributed to the release of Zn2+ ions. The critical force of scratching the chitosan/ZnO coating was approximately twice that of the chitosan coating. The potentiodynamic polarization results confirmed that the corrosion resistance of the implant with ZnO/chitosan/Ti structure was improved. In addition, cytocompatibility evaluation indicated that the chitosan/ZnO coating has good cytocompatibility in MG-63 cells as compared to pure Ti.

Creation of a Custom-Length, Humeral Antibiotic Cement Spacer for Use in Treatment of Shoulder Periprosthetic Joint Infection

Periprosthetic joint infection of the shoulder is a challenging clinical situation to manage owing to the fastidious organisms often present and delayed clinical presentation. While several treatment options have been described, the mainstay of treatment remains a staged revision with the use of a humeral antibiotic cement spacer. Such spacers are commercially available or can be made by hand. When an extended humeral osteotomy is required to remove a well-fixed long stem humeral component, it may be advantageous to place an antibiotic spacer with a stem length approximately as long as the hardware being removed. This technique demonstrates creation of a custom length, humeral antibiotic cement spacer for use in treatment of shoulder periprosthetic joint infection.

Antibiotic loaded \u03b2-tricalcium phosphate/calcium sulfate for antimicrobial potency, prevention and killing efficacy of Pseudomonas aeruginosa and Staphylococcus aureus biofilms

This study investigated the efficacy of a biphasic synthetic β-tricalcium phosphate/calcium sulfate (β-TCP/CS) bone graft substitute for compatibility with vancomycin (V) in combination with tobramycin (T) or gentamicin (G) evidenced by the duration of potency and the prevention and killing efficacies of P. aeruginosa (PAO1) and S. aureus (SAP231) biofilms in in vitro assays. Antibiotic loaded β-TCP/CS beads were compared with antibiotic loaded beads formed from a well characterized synthetic calcium sulfate (CS) bone void filler. β-TCP/CS antibiotic loaded showed antimicrobial potency against PAO1 in a repeated Kirby-Bauer like zone of inhibition assay for 6 days compared to 8 days for CS. However, both bead types showed potency against SAP231 for 40 days. Both formulations loaded with V + T completely prevented biofilm formation (CFU below detection limits) for the 3 days of the experiment with daily fresh inoculum challenges (P < 0.001). In addition, both antibiotic loaded materials and antibiotic combinations significantly reduced the bioburden of pre-grown biofilms by between 3 and 5 logs (P < 0.001) with V + G performing slightly better against PAO1 than V + T. Our data, combined with previous data on osteogenesis suggest that antibiotic loaded β-TCP/CS may have potential to stimulate osteogenesis through acting as a scaffold as well as simultaneously protecting against biofilm infection. Future in vivo experiments and clinical investigations are warranted to more comprehensively evaluate the use of β-TCP/CS in the management of orthopaedic infections.

The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates.

With many preventable causes of surgical site infections (SSIs) identified, the effect of operating room (OR) size on SSI rates has not been assessed. This study investigated the effect of OR size on incidence of SSIs for orthopaedic procedures. SSIs remain a common complication within the perioperative realm. Responsible for increasing length of hospitalization and costs, SSIs result in a decreased quality of life for patients. A retrospective review of 11,163 patients who underwent orthopaedic surgery-including total knee and hip arthroplasties, laminectomies, and spinal fusions-between January 2018 and January 2020 were reviewed. Total net square footage (NSF) of all ORs was recorded, and incidence of SSIs was calculated. Cases were categorized based on the size of the OR (small: 250 to 399 NSF; medium: 400 to 549 NSF; and large: 550 to 699 NSF). Chi-square analysis compared infection rates between the different OR sizes, and a binary logistic regression model identified other predictors of infection. Overall, 137 patients (1.2%) developed an SSI. Of these infections, 16 (11.7%) occurred in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. Factors found to significantly impact SSI's included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores (>3). Our study shows that OR size in addition to various other perioperative parameters plays a role in the rate of SSIs for orthopaedic procedures. Retrospective Cohort Study; Level III Evidence.

Properties of erythromycin-loaded polymeric dicalcium phosphate dehydratebone graft substitute.

A self-setting, injectable polymeric dicalcium phosphate dehydrate bone graft substitute that is mechanically strong and has excellent cohesion was developed. We assessed the performance of erythromycin-loaded polymeric dicalcium phosphate dehydrate cement. Its properties include drug release, growth inhibition against Staphylococcus aureus and biocompatibility with osteoblastic MC3T3 cells. The impact of erythromycin loading on cement injectability, setting time, and mechanical strength were also evaluated. A sustained, low burst release of erythromycin was observed. Eluents collected from erythromycin-loaded cement showed a considerable zone of inhibition for up to 28 days. Direct contact of erythromycin-loaded cement discs with agar plate showed a similarly sizable zone of inhibition for up to 22 days. Degraded ceramic residues had strong zones of inhibition as well. While the erythromycin-loaded cement was injectable, a notable delay of the setting time was observed (49.2 ± 6.8 min) as compared with control (drug-free cement, 12.2 ± 2.6 min). A slight increase in compressive strength (60.83 ± 6.28 MPa) was observed in erythromycin-loaded cement as compared with control (59.41 ± 6.48 MPa). Erythromycin-loaded cement was biocompatible although reduced cell growth was observed in the presence of the cement eluent. We propose that the bactericidal efficacy of erythromycin-loaded cement was caused by the combined effects of erythromycin released and exposed on the contact surface of degrading ceramics. Our data may elucidate the future application of polymeric dicalcium phosphate dehydrate bone graft substitute for the treatment of orthopedic infections and opportunities to use other antibiotics and applications considering its comparable handling and mechanical strength to poly (methyl methacrylate) cements.

Intravenous Regional Limb Perfusion in Standing and Recumbent Horses: A Comparative Radiographic Study

Although pharmacokinetic studies of drugs administered by intravenous regional limb perfusion (IRLP) to treat equine orthopedic infections suggest efficient drug distribution in the limbs, it remains unclear whether drug perfusion is affected by the position of the horse during the procedure. This study compared the perfusion of a radiopaque contrast into tissues of the extremities of horses maintained in standing and recumbent positions during an IRLP. Radiopaque contrast was administered through IRLP into the cephalic vein of 10 healthy adult horses under general anesthesia and right lateral recumbency (RG) or under sedation and standing (SG). The same animals were used in both groups, respecting a two-week washout period. Sequential radiographic images were performed immediately at the beginning of contrast administration (T0) and after 10, 20, 30, 40, and 50 minutes. Tourniquets were removed after 30 minutes. The time required for the contrast to reach the hooves was compared between groups. Contrast reached the hooves faster in SG (114 ± 15 seconds) compared with RG (236 ± 29 seconds) (P < 0.5). SG showed more uniform perfusion of the limb vessels, whereas RG showed more deposition of the contrast in the lateral digital vein, with smaller amounts reaching the hooves. From T10 onward, soft tissue radiopacity increased, albeit more markedly in standing than in recumbent animals, remaining until T50. Contrast radiography evidenced that IRLP performed in standing position leads to a quicker and more uniform perfusion of the vasculature and a more noticeable diffusion to the tissues than in recumbent horses.

Ionized jet deposition of antimicrobial and stem cell friendly silver-substituted tricalcium phosphate nanocoatings on titanium alloy

Orthopedic infections pose severe societal and economic burden and interfere with the capability of the implanted devices to integrate in the host bone, thus significantly increasing implants failure rate. To address infection and promote integration, here nanostructured antibacterial and bioactive thin films are proposed, obtained, for the first time, by Ionized Jet Deposition (IJD) of silver-substituted tricalcium phosphate (Ag-TCP) targets on titanium. Coatings morphology, composition and mechanical properties are characterized and proof-of-concept of biocompatibility is shown. Antimicrobial efficacy is investigated against four Gram positive and Gram negative bacterial strains and against C. albicans fungus, by investigating the modifications in planktonic bacterial growth in the absence and presence of silver. Then, for all bacterial strains, the capability of the film to inhibit bacterial adhesion is also tested. Results indicate that IJD permits a fine control over films composition and morphology and deposition of films with suitable mechanical properties. Biological studies show a good efficacy against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis and against fungus Candida albicans, with evidences of efficacy against planktonic growth and significant reduction of bacterial cell adhesion. No cytotoxic effects are evidenced for equine adipose tissue derived mesenchymal stem cells (ADMSCs), as no reductions are caused to cells viability and no interference is assessed in cells differentiation towards osteogenic lineage, in the presence of silver. Instead, thanks to nanostructuration and biomimetic composition, tricalcium phosphate (TCP) coatings favor cells viability, also when silver-substituted. These findings show that silver-substituted nanostructured coatings are promising for orthopedic implant applications.

Epidemiologic characteristics of orthopedic surgical site infections and under-reporting estimation of registries using capture-recapture analysis

BackgroundSurgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the under-reporting of registries using the capture-recapture method.MethodsThis study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and Health Information Management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patients` characteristics.ResultsTotally, 76.24% of SSIs were detected post-discharge. Staphylococcus aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95 and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552–695) and under-reporting percentage was 63.32%.ConclusionTo recognize the trends of SSIs mortality and morbidity in national level, it is significant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection Prevention and Control (IPC) programs and providing updated protocols is recommended.

Высокоэффективные оксиды серебра: влияние концентрации кислорода на антибактериальную активность в отношении клинических штаммов Staphylococcus aureus

Aim of study. Comparative analysis of antibacterial activity of silver oxides (Ag0,2O, Ag1 O, Ag2 O) in relation to clinical strains of Staphylococcus aureus obtained from patients with orthopaedic infection. Material and methods. Films of silver oxides were coated on paper surface in vacuum via the method of ion-plasma arc sputtering of the metallic target. Isolation of S.aureus was performed via standard manual methods from January to June 2021, identification was carried out via the MALDI-TOF-MS method. Sensitivity to antibiotics was evaluated according to EUCAST (2021, v.11.0) requirements. Antibacterial activity of the silver oxide samples obtained against 130 clinical strains of S.aureus was analysed in liquid nutrient broth with subsequent measurement of optical density. Results. Over 90% of the clinical strains of S.aureus isolated from patients with orthopaedic infection were sensitive to the silver oxides obtained. The amount of oxygen in the compound exerted almost no influence on the sensitivity to the oxides: even a minimum ratio between silver and oxygen provided a pronounced antibacterial effect. Additionally, the sensitivity to silver oxides did not depend on the MRSA resistance phenotype and the compounds were effective against XDR strains of S.aureus in 96.7% of the cases. Conclusion. All tested samples of silver oxides (Ag0,2O, Ag1 O, Ag2O) were characterised by pronounced antibacterial activity against S. aureus. The data obtained point to prospects in application of silver oxides for prevention and treatment of orthopaedic infection induced by Staphylococcus aureus without regard for the sensitivity phenotype of the pathogen.

Prevention of surgical site infections in orthopaedics

Prevention of surgical site infections in orthopaedics

Periprosthetic joint infections are different from osteosynthesis-associated infections

Aim: The aim of the study is comparing the treatment results and showing the differences between periprosthetic joint infectionsand osteosynthesis-associated infections.Materials and Methods: We retrospectively reviewed the cases of orthopedic implant-associated infections. All patients werecategorized into two groups; Group A has consisted of osteosynthesis-associated infections, and Group B has consisted ofperiprosthetic joint infection. The time interval between implantation and infection, length of hospitalization, number of operations,the status of preoperative and postoperative intensive care unit, and number of outpatient clinic applications were recorded. Culturedata from intraoperative deep tissue samples were also recorded.Results: There were 28 patients in Group A and 20 patients in Group B. The age distributions and operation numbers were significantlydifferent between the two study groups (p=0.000 and p=0.05, respectively). There was a significant difference between the numberof outpatient clinic applications and the success of treatment (p=0.016). There was a significant difference between the post-operatively intensive care unit status and success of treatment (p=0.002).Conclusion: Periprosthetic joint infection patients were older and had a higher number of operations, however orthopedic implant-associated infections were more likely outpatient clinic applications and post-operatively intensive care unit status.

Antimicrobial Peptides in the Battle Against Orthopedic Implant-Related Infections – A Review

Prevention of orthopedic implant-related infections is a major medical challenge, particularly due to the involvement of biofilm-encased and multidrug-resistant bacteria. Current therapies, based on antibiotic administration, have proven to be insufficient, and infection prevalence may rise due to the dissemination of antibiotic resistance.Antimicrobial peptides (AMPs) have attracted attention as promising substitutes of conventional antibiotics, owing to their broad-spectrum of activity, high efficacy at very low concentrations, and importantly low propensity for inducing resistance. The current review focuses on the potential of using AMPs as a preventive strategy for orthopedic implant-related infections. This review addresses current progress in AMP-based approaches designed to both benefit from the key role envisioned for AMPs in the post-antibiotic era and overcome the limitations of peptides as therapeutics. Particular attention is given to application of AMPs onto titanium orthopedic and dental implants, and on encouraging achievements that pave the way for future research in this field.

Microbiological profile and antibiotic sensitivity pattern of post-operative orthopaedic Implant infections in tertiary care hospital

Background: A correct information about most common causative organism and it sensitivity pattern in that clinical setup is essential for designing empirical therapy. Present study has been designed to study the microbiological profile and antibiotic sensitivity pattern of post-operative orthopaedic Implant infections in tertiary care teaching hospital.Material and Method: This prospective observational study. Patients who presented with the signs and symptoms of infections, confirmed by laboratory and other routine investigations, were included in present study. The demography, microbiological data sensitivity to antimicrobial agent of organism was recorded.Result: The most common pathogen isolated was pseudomonas aeruginosa that is 52(43.3 %), followed by staphylococcus aureus that is 50(41.66%). Pseudomonas aeruginosa was sensitive to Piperacillin tazobactam 42(80.7%), Imipenem 40(76.9%), Imipenem+cilastatin 42(80.7%) and Meropenem 43(82.7%). Methicillin resistant staph aureus were sensitive to Cotrimoxazole 6(50%), Clindamycine 9(75%), Vancomycin 11(91.7%) and Linazolid10 (83.4%).Conclusion: Implant of femur was most commonly infected. Staphylococcus Aureus (MSSA) was commonly associated with biofilm formation followed by Staphylococcus Aureus (MRSA). Pseudomonas aeruginosa isolated from implant infections were sensitive to Piperacillin+ tazobactam, Imipenem, Imipenem+cilastatin and Meropenem.

Сравнительная оценка поведения гелей на основе поливинилпирролидона в условиях in vitro и in vivo

A series of experiments aimed at studying antimicrobial properties of gel experimental samples has been carried out, and their prolonged action in vivo and in vitro has been compared. The gel under study is a processed composition based on polyvinylpyrrolidone (PVP) and antimicrobial drugs; it is intended for the prevention and treatment of implant-associated infection in traumatology and orthopedics. Two methods were used to process the composition: ionizing radiation and heating. PVP treated in this way is a matrix for drug delivery to the structures of the articular cavity, which allows using antimicrobial medicines, in particular gentamicin and fosfomycin, for targeted influence on infectious agents. All gel samples, regardless of the method for their preparation, exhibited antimicrobial activity against Staphylococcus aureus, the main causative agent of postoperative infectious processes. The antimicrobial properties of the gel were long-lasting; they were observed for 14 days. No pathological changes were found in the tissues adjacent to the gel. Key words: implant-associated infection, surgery, traumatology, biofilm, polymer hydrogel, gentamicin, fosfomycin

Value of D-Dimer as a Diagnostic Marker of Infection Associated with Orthopedic Implants.

Background:Recently, the D-dimer biomarker has gained the researchers' attention for predicting infections. We aimed to determine the relationship between this marker and other inflammatory markers involved in orthopedic implant-associated infections.Materials and Methods:In this study, all patients diagnosed with an orthopedic implant-associated infection were investigated in 3 years. The serum level of D-dimer, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) was measured. Infection was diagnosed based on the clinical and culture results of biopsy samples.Results:The cultured microorganisms, detected in 26 patients with infections, included Staphylococcus aureus (n = 13, 50%), Staphylococcus epidermidis (n = 2, 7.7%), Klebsiella aerogenes (n = 8, 30.8%), and Pseudomonas aeruginosa (n = 3, 11. 5%). Based on laboratory findings, there was a significant difference in the CRP level and ESR (P = 0.001). Although the level of D-dimer was higher in infected patients, compared to the controls (992.6 ± 667.2 vs. 690.1 ± 250.2 ng/mL), the difference was not statistically significant. There was no significant correlation between the elevated D-dimer level and CRP level, whereas ESR had a positive correlation with the elevated D-dimer level (r = 0.6, P = 0.03). The sensitivity, specificity, and positive predictive value (PPV) of D-dimer in the prediction of infection were 65%, 57%, and 45%, respectively. Furthermore, the sensitivity, specificity, and PPV of CRP were 100%, 92.3%, and 95%, respectively, whereas the corresponding values for ESR were 85%, 69.2%, and 62%, respectively.Conclusion:Measurement of the serum D-dimer level is not efficient for the diagnosis of orthopedic implant-associated infections due to its low predictive value. Furthermore, there was no significant correlation between the serum D-dimer level and CRP.