Thromboelastography parameters in diagnosing periprosthetic joint infection and predicting reimplantation timing

Abstract Background Coagulation-related biomarkers are drawing new attention in the diagnosis of periprosthetic joint infection (PJI). The thromboelastography (TEG) assay provides a comprehensive assessment of blood coagulation; therefore, it could be a promising test for PJI. This study aims to assess the value of TEG in diagnosing PJI and to determine the clinical significance of TEG in analysing reimplantation timing for second-stage revision. Methods From October 2017 to September 2020, 62 patients who underwent revision arthroplasty were prospectively included. PJI was defined by the 2011 Musculoskeletal Infection Society criteria, in which 23 patients were diagnosed with PJI (Group A), and the remaining 39 patients were included as having aseptic loosening (Group B). In group A, 17 patients completed a two-stage revision in our centre. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, and TEG parameters (clotting time, α-angle, MA [maximum amplitude], amplitude at 30 min, and thrombodynamic potential index) were measured preoperatively in all included patients. In addition, receiver operating characteristic curves were used to evaluate the diagnostic value of these biomarkers. Results ESR (area under curve [AUC], 0.953; sensitivity, 81.82; specificity, 94.87) performed best for PJI diagnosis, followed by MA (AUC, 0.895; sensitivity, 82.61; specificity, 97.44) and CRP (AUC, 0.893; sensitivity, 82.61; specificity, 94.74). When these biomarkers were combined in pairs, the diagnostic value improved compared with any individual biomarker. The overall success rate of the two-stage revision was 100%. Furthermore, ESR and MA were valuable in determining the time of reimplantation, and their values all decreased below the cut-off values before reimplantation. Conclusion TEG could be a promising test in assisting PJI diagnosis, and a useful tool in judging the proper timing of reimplantation.

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Thromboelastography Performs Well for the Diagnosis of Periprosthetic Joint Infection.

10.21203/rs.3.rs-257605/v1 ◽

2021 ◽

Author(s):

Tao Yuan ◽

Yi Wang ◽

Shui Sun

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Maximum Amplitude ◽

Diagnostic Value ◽

Two Stage ◽

Musculoskeletal Infection ◽

Group A ◽

Group B ◽

Α Angle

Abstract Background: Coagulation-related biomarkers are drawing new attention in diagnosing periprosthetic joint infection (PJI). Thromboelastography (TEG) analysis provides a comprehensive assessment of coagulation and therefore could be a promising test for PJI. This study aims to assess the value of TEG in diagnosing PJI and to determine the clinical significance of TEG in analyzing reimplantation timing for the second-stage revision.Methods: From October 2017 to September 2020, 62 patients who underwent revision arthroplasty were prospectively included, PJI was defined by 2011 Musculoskeletal Infection Society (MSIS) criteria. Twenty-three patients were diagnosed with PJI (Group A) and the other 39 patients were included as aseptic loosen (Group B). Seventeen patients in Group A finished two-stage revision in our center. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer and TEG parameters (K (clotting time), Angle (α-angle), MA (maximum amplitude), A30 (amplitude at 30 min), TPI (thrombodynamic potential index)) were measured preoperatively in all included patients. Receiver operating characteristic curves were applied to evaluate the diagnostic value of these biomarkers.Results: ESR (AUC 0.953, sensitivity 81.82, specificity 94.87) performed best in PJI diagnosis, followed by MA (AUC 0.895, sensitivity 82.61, specificity 97.44) and CRP (AUC 0.893, sensitivity 82.61, specificity 94.74). When these biomarkers combined in pairs, the diagnosis value improved compared with any individual biomarker. The overall success rate of the two-stage revision was 100%. ESR and MA showed valuable in determining the time of reimplantation, with their values all decreased below cut-off values before reimplantation.Conclusion: TEG could be a promising test in assisting PJI diagnosis, and a useful tool in judging the proper timing of reimplantation.

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Does serum interleukin-6 guide the diagnosis of persistent infection in two-stage hip revision for periprosthetic joint infection?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1448-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Peng-Fei Qu ◽

Chi Xu ◽

Jun Fu ◽

Rui Li ◽

Wei Chai ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Interleukin 6 ◽

Persistent Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Roc Curves ◽

Two Stage ◽

Predictive Values ◽

Musculoskeletal Infection ◽

Significant Difference

Abstract Purpose The diagnosis of persistent infection at reimplantation of two-stage revision arthroplasty for periprosthetic joint infection (PJI) remains challenging. Several studies have shown the benefit of serum interleukin-6 (IL-6) in diagnosing periprosthetic joint infection (PJI). Recent data indicated serum IL-6 could be promising in differentiating persistent infection. The purpose of this study was to validate the efficacy of serum IL-6 in diagnosing persistent infection at reimplantation. Methods A retrospective review of 86 PJI patients with a two-stage exchanged hip arthroplasty from 2013 to 2017 was conducted. Persistent infection was defined using the modified Musculoskeletal Infection Society (MSIS) criteria combined with follow-up results. Serum IL-6 at reimplantation were collected and compared among patients with or without persistent infection. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic performance and optimal cut-off value of serum IL-6 at reimplantation. Results Sixteen cases were diagnosed as persistent infection at reimplantation. There was no significant difference in serum IL-6 levels between cases with persistent infection and controls (7.89 pg/ml vs. 5.56 pg/ml; P = 0.179). The area under the ROC curve (AUC) for serum IL-6 in diagnosing persistent infection at reimplantation was 0.59 (95% confidential interval [CI] 0.40–0.77). With the calculated threshold set at 8.12 pg/ml, the corresponding sensitivity, specificity, positive predictive value, and negative predictive values were 38%, 88%, 38%, and 87%, respectively. Conclusion Serum IL-6 is inadequate in diagnosing persistent infection at reimplantation for two-stage revision arthroplasty. With the serum IL-6 threshold set at 8.12 pg/ml, the specificity to rule out persistent infection is high, but the sensitivity to predict persistent infection is not satisfactory.

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Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection

Journal of Clinical Medicine ◽

10.3390/jcm9092917 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2917

Author(s):

Thomas Ackmann ◽

Burkhard Möllenbeck ◽

Georg Gosheger ◽

Jan Schwarze ◽

Tom Schmidt-Braekling ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Joint Infection ◽

Revision Arthroplasty ◽

Preoperative Assessment ◽

Diagnostic Value ◽

Musculoskeletal Infection ◽

Prosthetic Joint ◽

The Individual ◽

Low Sensitivity ◽

D Dimer

Introduction: D-dimer is a diagnostic criterion for periprosthetic joint infection (PJI) of the Musculoskeletal Infection Society (MSIS) in 2018. The aim of this study was to evaluate the serum D-dimer values in comparison to C-reactive protein (CRP) and interleukin-6 (IL-6) for the diagnosis of PJI. Materials and Methods: We included 119 patients (50 women, 69 men; 71 knees, 48 hips) undergoing revision arthroplasty with preoperative assessment of CRP, IL-6, and serum D-dimer. Cases were classified as infected or aseptic based on the MSIS criteria of 2018. Receiver operating curves and Youden’s index were used to define an ideal cut-off value and sensitivity and specificity for the individual parameters, and respective combinations were calculated using cross-tables. Results: The median D-dimer level (2320 vs. 1105 ng/mL; p < 0.001), the median CRP level (4.0 vs. 0.5 mg/dL; p < 0.001), and the median IL-6 level (21.0 vs. 5.0 pg/mL; p < 0.001) were significantly higher in the group of PJI compared to the group with aseptic failure. The calculated optimal cut-off values were 2750 ng/mL (AUC 0.767) for D-dimer, 1.2 mg/dL (AUC 0.914) for CRP, and 10.0 pg/mL (AUC 0.849) for IL-6. D-dimer showed a sensitivity of 38% and specificity of 94%, whereas the CRP and IL-6 had sensitivities of 88% and 76%, and specificities of 87% and 92%, respectively. Conclusion: In comparison with CRP and IL-6, serum D-dimer showed low sensitivity and specificity in our cohort. While CRP and IL-6 combination had the highest sensitivity, a combination of Il-6 and D-dimer or CRP and IL-6 had the highest specificity.

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Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

World Journal of Orthopedics ◽

10.5312/wjo.v10.i10.348 ◽

2019 ◽

Vol 10 (10) ◽

pp. 348-355 ◽

Cited By ~ 2

Author(s):

Ewout S Veltman ◽

Dirk Jan F Moojen ◽

Marc L van Ogtrop ◽

Rudolf W Poolman

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Two Stage

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Value of mNGS in sonication fluid for the diagnosis of periprosthetic joint infection

Arthroplasty ◽

10.1186/s42836-019-0006-4 ◽

2019 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Chongjing Zhang ◽

Xinyu Fang ◽

Zida Huang ◽

Wenbo Li ◽

Chao-fan Zhang ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Pathogenic Microorganisms ◽

Musculoskeletal Infection ◽

Conventional Culture ◽

Culture Positive ◽

Positive Results ◽

Aseptic Failure ◽

Fluid Culture

Abstract Objective To evaluate the effectiveness of metagenomics next-generation sequencing (mNGS) for the detection of pathogenic microorganisms in periprosthetic joint infection (PJI) using the sonication fluid from removed prosthesis. Methods In this prospective diagnostic cohort study, 44 patients who underwent revision arthroplasty in our hospital from December 2016 to December 2018 were screened. Seven cases were excluded due to incomplete clinical data, insufficient synovial fluid or failure of sequencing. According to the PJI diagnostic criteria recommended by the Musculoskeletal Infection Society (MSIS), the patients were defined as PJI or aseptic failure (AF). Conventional culture, sonication fluid culture and mNGS were performed, in order to assess the value of mNGS using sonication fluid for the diagnosis of PJI, and the mNGS results were analyzed and compared with the conventional and sonication fluid culture. Results Among the 37 patients, 24 were diagnosed with PJI (64.86%), while 13 were diagnosed with aseptic failure. Among the 24 patients diagnosed with PJI, 15 cases (62.5%), 17 cases (70.8%) and 24 cases (100%) yielded positive results in conventional culture, sonication fluid culture and mNGS, respectively. In addition, mNGS detected the same pathogenic microorganisms in 16 out of the 17 (94.12%) culture-positive (conventional + sonication fluid) PJI cases. In the only one discrepancy case, Enterococcus faecalis was identified in the cultures, while Enterobacter cloacae was detected by mNGS. In the AF group, the results of the conventional culture were all negative. Nevertheless, Staphylococcus epidermidis was detected in the sonication fluid culture and mNGS in one case. The diagnostic sensitivity of mNGS for PJI was 100%, which was significantly higher than 70.83% (P = 0.039) of the sonication fluid culture and 62.5% (P = 0.021) of the conventional culture. The diagnostic specificity of mNGS for PJI was 92.31%, which was not significantly different (P > 0.05) from those of the conventional culture (100%) and sonication fluid culture (92.31%). Conclusion We demonstrated that mNGS using sonication fluid can improve the detection rate of pathogenic microorganisms and provide valuable information for the diagnosis of PJI. In addition, mNGS can effectively identify pathogenic microorganisms in culture-negative PJIs cases, especially for the cases who have been treated with antibiotics before sample acquisition or have fastidious microorganisms. Therefore, this method can potentially help to guide the clinical use of antibiotics.

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The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03317-1 ◽

2019 ◽

Vol 140 (2) ◽

pp. 255-262 ◽

Cited By ~ 1

Author(s):

Martin Thaler ◽

Ricarda Lechner ◽

Dietmar Dammerer ◽

Hermann Leitner ◽

Ismail Khosravi ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Anterior Approach ◽

Joint Infection ◽

Revision Arthroplasty ◽

Direct Anterior Approach ◽

Two Stage

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The serum level of D-Dimer is not suitable for distinguishing between prosthetic joint infection and aseptic loosening

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1461-x ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 12

Author(s):

Jincheng Huang ◽

Yongchao Zhang ◽

Zhen Wang ◽

Yonghui Dong ◽

Yongqiang Zhao ◽

...

Keyword(s):

Aseptic Loosening ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Primary Arthroplasty ◽

Prosthetic Joint ◽

Group A ◽

Group B ◽

Serum Crp ◽

D Dimer

Abstract Background To evaluate the meaning of serum CRP, ESR, and D-Dimer in the diagnosis of prosthetic joint infection. Methods In a retrospective study, 101 patients presented with osteoarthritis, PJI, and aseptic loosening were divided into three groups according to the type of operation they received in our department from June 2016 to December 2018: group A, 44 patients treated with primary arthroplasty; group B, 31 PJI patients treated with resection arthroplasty and spacer insertion surgery; group C, 26 aseptic loosening patients treated with revision arthroplasty. Data such as gender, age, preoperative serum CRP, ESR, and D-Dimer level were compared among the three different groups. Results There are no statistically significant differences when comparing general data such as gender and age in patients from the three different groups. However, Serum CRP level in group B (43.49 ± 10.00 mg/L) is significantly higher than in group A (2.97 ± 0.75 mg/L) and C (4.80 ± 1.26 mg/L). Serum ESR level in group B (49.84 ± 5.48 μg/L) is significantly higher than those in group A (15.28 ± 2.63 μg/L) and C (22.50 ± 3.47 μg/L). Serum D-Dimer level in group B (1.58 ± 0.17 μg/L) is significantly higher than that in group A (0.51 ± 0.50 μg/L), but similar with group C (1.22 ± 0.29 μg/L). There are no statistically significant differences when compared with sensitivity and specificity of CRP, ESR, and D-Dimer in the diagnosis of PJI among patients from the three different groups when D-Dimer > 0.85 μg/L was set as the optimal threshold value for the diagnosis of PJI. Conclusion D-Dimer is not a parameter to distinguish between aseptic loosening and PJI.

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Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

World Journal of Orthopedics ◽

10.5312/wjo.v10.i10.340 ◽

2019 ◽

Vol 10 (10) ◽

pp. 340-347

Author(s):

Ewout S Veltman ◽

Dirk Jan F Moojen ◽

Marc L van Ogtrop ◽

Rudolf W Poolman

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Two Stage

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Serum D-Lactate, a Novel Serological Biomarker, Is Promising for the Diagnosis of Periprosthetic Joint Infection

10.21203/rs.3.rs-1216974/v1 ◽

2022 ◽

Author(s):

Yanyang Chen ◽

Huhu Wang ◽

Xiyao Chen ◽

Hairong Ma ◽

Jingjie Zheng ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Operating Characteristic ◽

Point Of Care ◽

Joint Infection ◽

Revision Arthroplasty ◽

Roc Curves ◽

Serological Screening ◽

Musculoskeletal Infection ◽

Highly Sensitive ◽

Diagnostic Values

Abstract Background: Although many markers are used for diagnosis of periprosthetic joint infection (PJI), serological screening and diagnosis for PJI are still challenging. We evaluated the performance of serum D-lactate and compared it with ESR, coagulation-related biomarkers and synovial D-lactate for the diagnosis of PJI.Methods: Consecutive patients with preoperative blood and intraoperative joint aspiration of a prosthetic hip or knee joint before revision arthroplasty were prospectively included. The diagnosis of PJI was based on the criteria of the Musculoskeletal Infection Society, and the diagnostic values of markers were estimated based on receiver operating characteristic (ROC) curves by maximizing sensitivity and specificity using optimal cutoff values.Results: Of 52 patients, 26 (50%) were diagnosed with PJI, and 26 (50%) were diagnosed with aseptic failure. ROC curves showed that serum D-lactate, fibrinogen (FIB) and ESR had equal areas under the curve (AUCs) of 0.80, followed by D-dimer and fibrin degradation product, which had AUCs of 0.67 and 0.69, respectively. Serum D-lactate had the highest sensitivity of 88.46% at the optimal threshold of 1.14 mmol/L, followed by FIB and ESR, with sensitivities of 80.77% and 73.08%, respectively, while there were no significant differences in specificity (73.08%, 73.08% and 76.92%, respectively). Conclusion: Serum D-lactate showed similar performance to FIB and ESR for diagnosis of PJI. The advantages of serum D-lactate are pathogen-specific, highly sensitive, minimally invasive and rapidly available making serum D-lactate useful as a point-of-care screening test for PJI.

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