scholarly journals Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

2020 ◽  
Author(s):  
Qiao Jiang ◽  
Xue Yang ◽  
Chi Xu ◽  
Wei Chai ◽  
Yong-gang Zhou ◽  
...  
Keyword(s):  
Serum Markers ◽  
Serum Biomarkers ◽  
Causative Organism ◽  
Value Change ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Percent Change ◽  
Proper Timing ◽  
Exchange Arthroplasty

Abstract Background Two-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in the first stage, the proper timing of reimplantation is crucial for successful treatment. To date, there is no gold standard to evaluate the eradication of PJI before reimplantation. A combination of serum indicators, synovial blood white cell (WBC) counts, culture results, intraoperative histology, and clinical symptoms is wildly used to guide the timing of reimplantation. However, the proper timing of reimplantation is not clearly defined. We investigated whether: (1) serum indicators, which included the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, were useful indicators for predicting the failure of reimplantation; and (2) primary culture results were related to serum marker changes? Method A retrospective review of 109 patients treated with two-stage exchange arthroplasty from 2014 to 2017 was conducted. The inclusion criteria included the following: 1. a minimum of a 2-year follow-up or failure of treatment within this period; 2. complete record of serum biomarkers; and 3. met the Musculoskeletal Infection Society criteria (MSIS) when diagnosed PJI. Serum biomarkers and organism results at the onset of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 years, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in four serum markers for predicting failure. Results When predicting persistent PJI, the area under the ROC curves (AUC) demonstrated that both the percent change and value change of serum markers were poor indicators. When comparing exact values of serum markers during reimplantation, the values of CRP and fibrinogen were significant higher in reinfection group. Besides, initial causative organism didn’t influence the normalize of serum markers. Conclusion Either the value change or percent change of serum markers were not useful for determining the timing of reimplantation, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still difficult to diagnose.

scholarly journals Change in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange ArthroplastyChange in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

2020 ◽  
Author(s):  
Qiao Jiang ◽  
Xue Yang ◽  
Chi Xu ◽  
Wei Chai ◽  
Yong-gang Zhou ◽  
...  
Keyword(s):  
Persistent Infection ◽  
Treatment Success ◽  
Serum Markers ◽  
Causative Organism ◽  
Value Change ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Percent Change ◽  
Proper Timing ◽  
Exchange Arthroplasty

Abstract BackgroundTwo-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in first stage, the proper timing of reimplantation is crucial for successful treatment. So far, there is no gold reference to determine the eradication of PJI before reimplantation. The combination of serum indicators, synovial white cell count (WBC), culture results, intraoperative histology, and clinical symptoms is used extensively to guide the timing of reimplantation. However, the proper timing of reimplantation was ill defined.PurposeWe wonder: (1) the utility of serum indicators, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, when predicted failure of reimplantation; (2) correlation between primary culture results and serum markers’ change.MethodA retrospective review of 226 patients treated with a two-stage exchange arthroplasty from 2014 to 2017 was conducted. PJI was diagnosed by using the Musculoskeletal Infection Society (MSIS) criteria. Serum biomarkers and organisms results at the set of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 year; receiver operator characteristic (ROC) depicted the utility of change in four serum markers when predicted failure.ResultsThe ROC area under the curves (AUC) was 0.543 in CRP, 0.572 in IL-6, 0.621 in ESR, 0.463 in fibrinogen and the combination of them was 0.709 when predicted persistent PJI using value change. The AUC of ROC was 0.521 in CRP, 0.472 in IL-6, 0.413 in ESR, 0.552 in fibrinogen and the combination was 0.630 when determine reimplantation by percent change. No significant association was found between culture results and change in serum markers.ConclusionNeither percent change nor value change in serum makers was proved to be poor markers when predicted persistent PJI, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still tough to diagnose. The combination of clinical symptom, pathology results, synovial fluid analysis and serum markers may improve the utility.

scholarly journals Changes in serum markers failed to predict persistent infection after two-stage exchange arthroplasty

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Qiao Jiang ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-bo Hao ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Persistent Infection ◽  
Serum Markers ◽  
Two Stage ◽  
Exchange Arthroplasty

scholarly journals Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

2020 ◽  
Author(s):  
Jing Wang ◽  
Honghai Hu ◽  
Xiaowei Liu ◽  
Shenglong Zhao ◽  
Yuanyuan Zheng ◽  
...  
Keyword(s):  
Plasminogen Activator Inhibitor ◽  
Serum Levels ◽  
Serum Markers ◽  
Serum Biomarkers ◽  
Operating Characteristics ◽  
Serum Samples ◽  
Predictive Values ◽  
A Prospective Study ◽  
Activator Inhibitor

Abstract Background: Preeclampsia prediction improves maternal and fetal outcomes in pregnancy. We aimed to evaluate the preeclampsia prediction values of a series of serum biomarkers. Methods: Singleton pregnant women with preeclampsia-related clinical and/or laboratory presentations were recruited and had blood drawn at their first visits. The prospective cohort was further divided into preeclampsia-positive and preeclampsia-negative groups based on the follow-up results. The following markers were tested using the collected serum samples: soluble fms-like tyrosine kinase-1 ( sFlt-1); placental growth factor (PlGF); thrombomodulin (TM); tissue plasminogen activator inhibitor complex (tPAI-C); compliment factors C1q, B, and H; glycosylated fibronectin (GlyFn); pregnancy-associated plasma protein-A2 ( PAPP-A2); blood urea nitrogen (BUN); creatinine (Cre); uric acid (UA); and cystatin C (Cysc). Results: A total of 196 women with suspected preeclampsia were recruited with follow-up medical records. Twenty-five percent (n=49) of the recruited subjects developed preeclampsia before delivery, and 75% remained preeclampsia-negative (n=147). The serum levels of sFlt-1, BUN, Cre, UA, Cysc and PAPP-A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia-positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt-1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP-A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP-A2). With the cut-off values obtained from the ROC analyses, the positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions: Further studies are warranted to confirm the clinical utilities of the serum markers in preeclampsia prediction

scholarly journals Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

2020 ◽  
Author(s):  
Qiao Jiang ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-bo Hao ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Persistent Infection ◽  
Treatment Success ◽  
Serum Markers ◽  
Two Stage ◽  
International Consensus ◽  
Variation Trend ◽  
Reactive Protein ◽  
Proper Timing ◽  
Significant Difference ◽  
Value Changes

Abstract Background The proper timing of reimplantation is importation to treatment success in two-stage exchange revision. The 2018 International Consensus Meeting suggested that a variation trend toward normalization in serum markers was useful for determining the proper timing of reimplantation. However, the opposite results were found that by previous studies, and the normalization of serum markers was reported to fail to predict infection control. We investigated whether value changes and percent changes in four common serum markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen) can predict persistent infection?Methods A retrospective review of 141 patients treated with two-stage revision from 2014 to 2018 was conducted. The variation trend in serum indicators was evaluated by the percent changes (using values of serum markers prereimplantation divided by values preresection) and value changes (using values of serum markers preresection minus values prereimplantation). Treatment success was defined according to the Delphi-based consensus criteria with a minimum follow-up of 1 year, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in serum markers.Results 22 patients (15.60%) were persistently infected. No significant difference was found in either the value change or percent change in serum markers between reinfection and non-reinfection patients. When predicting persistent infection, the area under the curves (AUC) demonstrated that both percent changes and value changes in serum markers were poor indicators. The AUC of value changes was 0.533 for the CRP, 0.504 for the IL-6, 0.508 for the ESR and 0.586 for fibrinogen when predicted persistent PJI. In addition, the AUC indicated that percent changes in the CRP (0.464), the IL-6 (0.534), the ESR (0.527) and fibrinogen (0.586) were all poor markers.Conclusions We have shown that both value changes and percent changes in serum markers were not sufficiently rigorous to aid in persistent infection diagnosis. The proper timing of reimplantation must therefore take into account various clinical tests rather than the downward trend of serum markers only.

scholarly journals Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?

2022 ◽  
Author(s):  
A. C. Steinicke ◽  
J. Schwarze ◽  
G. Gosheger ◽  
B. Moellenbeck ◽  
T. Ackmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Rank Test ◽  
Success Rates ◽  
Two Stage ◽  
Second Stage ◽  
Exchange Arthroplasty ◽  
Parametric Testing

Abstract Introduction Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure. Materials and methods We retrospectively identified 55 patients (23 hips, 32 knees) who were treated with repeat resection arthroplasty and planned delayed reimplantation for recurrent periprosthetic joint infection between 2010 and 2019 after a prior two-stage revision at the same institution. The minimum follow-up was 12 months with a median follow-up time of 34 months (IQR 22–51). The infection-free survival, associated revision surgeries, and potential risk factors for further revision were analyzed using Kaplan–Meier survival curves and comparative non-parametric testing. Results 78% (43/55) underwent reimplantation after a repeat implant removal. Of those who completed the second-stage surgery, 37% (16/43) underwent additional revision for infection and 14% (6/55) underwent amputation. The reinfection-free implant survivorship amounted to 77% (95% CI 64–89%) after 1 year and 38% (95% CI 18–57%) after 5 years. Patients with a higher comorbidity score were less likely to undergo second-stage reimplantation (median 5 vs. 3, p = 0.034). Furthermore, obese patients (p = 0.026, Fisher’s exact test) and diabetics (p < 0.001, log-rank test) had a higher risk for further infection. Most commonly cultures yielded polymicrobial growth at the repeat two-stage exchange (27%, 15/55) and at re-reinfection (32%, 9/28). Pathogen persistence was observed in 21% (6/28) of re-reinfected patients. Conclusion The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.

Complications in the treatment of prosthetic joint infection

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 145-150 ◽  
Author(s):  
Molly A. Hartzler ◽  
Katherine Li ◽  
Michael B. Geary ◽  
Susan Marie Odum ◽  
Bryan D. Springer
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Definitive Treatment ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint ◽  
Definition Of Success ◽  
One Year ◽  
Definition Of

Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.

scholarly journals Two-stage exchange Arthroplasty is a viable treatment for Periprosthetic joint infection in inflammatory diseases

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiao Jiang ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-Bo Hao ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Inflammatory Diseases ◽  
Joint Infection ◽  
Treatment Success ◽  
Serum Markers ◽  
Control Group ◽  
Two Stage ◽  
Fluid Analysis ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint

Abstract Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases. Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8 ± 1385.3*109/mL) and group C (1315.8 ± 1849.3*109/mL, p = 0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group. Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.

scholarly journals Complications in the treatment of periprosthetic joint infection of the hip: when do they occur?

2021 ◽  
Vol 6 (7) ◽  
pp. 295-303
Author(s):  
Katherine Li ◽  
Mario Cuadra ◽  
Gregory Scarola ◽  
Susan Odum ◽  
Jesse Otero ◽  
...  
Keyword(s):  
Surgical Complication ◽  
Joint Infection ◽  
Additional Treatment ◽  
Medical Complication ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Prosthetic Joint ◽  
Additional Surgery ◽  
The Usa

Abstract. Prosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA). The common treatment in the USA is a two-stage exchange which can be associated with significant morbidity and mortality. The purpose of this study was to analyze complications in the treatment course of patients undergoing two-stage exchange for PJI THA and determine when they occur. Methods: We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI after THA from January 2005 to January 2018 at a single institution. Complications were categorized as medical or surgical and divided into interstage and post-reimplantation. Minimum follow-up was 1 year. Success was based on the MusculoSkeletal Infection Society (MSIS) definition. Results: 205 hips (203 patients) underwent first stage of planned two-stage exchange. The median age was 68 (interquartile range (IQR) 18). There were 97 males and 106 females. Overall, 73/205 (38 %) patients had at least one complication during treatment: 13.5 % (25/185) of patients experienced a medical complication and 28.1 % (52/185) a surgical complication; 2.4 % died within 1 year of surgery, and 4.9 % (15/203) had mortality at a median of 2.5 years (IQR 4.9); 27 % of patients had complications during the interstage period, most commonly being recurrence of infection requiring additional surgery (63 %); and 14 % of patients experienced a complication following reimplantation, most commonly persistence or recurrence of infection (59 %). While 92 % of patients that initiated treatment were ultimately reimplanted, only 69 % were infection free at 1 year and required no additional treatment. Conclusions: While two-stage exchanges for PJI in THA have been reported as successful, there are few reports of the complications during the process. In our series, significant numbers of patients experienced complications, often during the interstage period, highlighting the morbidity of this method of treatment.

scholarly journals Diagnosis and management of infected arthroplasty

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 54
Author(s):  
Tejbir S. Pannu ◽  
Jesus M. Villa ◽  
Carlos A. Higuera
Keyword(s):  
Joint Infection ◽  
Treatment Options ◽  
Clinical Situation ◽  
The United States ◽  
Sinus Tract ◽  
Two Stage ◽  
International Consensus ◽  
Musculoskeletal Infection ◽  
One Stage ◽  
Exchange Arthroplasty

Periprosthetic joint infection (PJI) is one of the most dreadful complications after THA and TKA. Though prevention is of utmost importance in PJI management, the last decade has seen many remarkable developments in PJI diagnosis, including the introduction of several standardized PJI diagnostic definitions and biomarkers. Depending on the specific clinical situation, a myriad of treatment options for PJI are offered. Our review aims to summarize the pertinent information on PJI diagnosis and synthesize literature on the different treatment methods currently used in clinical practice. One of the most accepted PJI diagnostic definitions was developed by the Musculoskeletal Infection Society (MSIS) in 2011, later modified in the 2013 International Consensus Meeting (ICM). After promising results from studies, alpha-defensins and D-dimer were recently incorporated into the 2018 ICM PJI definition. The management choices for PJI include irrigation and debridement (DAIR), one-stage exchange arthroplasty, or two-stage exchange arthroplasty, to name a few. While two-stage revision has traditionally been the treatment of choice in the United States, there has been a growing body of evidence framing one-stage revision as a comparable choice. One-stage revision should be offered in patients meeting strict selection criteria: no sinus tract, proper soft tissue available for wound closure, appropriate bone stock, a favorable identifiable organism with encouraging antibiotic sensitivities (for cement and oral suppression later), and robust immunological status. DAIR can be considered in case of early infections with sensitive infecting organisms. Patients with multiple unsuccessful revisions or those who refuse further surgical intervention for PJI can be offered antibiotic suppression. If nothing seems to work, salvage procedures (resection arthroplasty and arthrodesis) are available as a last resort. Further research is encouraged to improve on diagnostic capabilities and develop evidence on the best treatment of choice for PJI.

scholarly journals Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

2020 ◽  
Author(s):  
Jing Wang ◽  
Honghai Hu ◽  
Xiaowei Liu ◽  
Shenglong Zhao ◽  
Yuanyuan Zheng ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Prospective Cohort ◽  
Serum Markers ◽  
Serum Biomarkers ◽  
Clinical Implementation ◽  
Operating Characteristics ◽  
Serum Samples ◽  
Multisystem Disorder ◽  
Predictive Values

Abstract Background: Preeclampsia is a common obstetric multisystem disorder causing maternal and fetal morbidity and mortality; it’s been shown that the prediction improves preeclampsia outcomes in pregnancy. However, the current serum biomarkers had low clinical application values and still lack validation studies. Here we aimed to evaluate the preeclampsia prediction values of a series of serum biomarkers in Chinese pregnant women of > 20 weeks of gestation. Methods: Singleton pregnant women with preeclampsia-related clinical and/or laboratory presentations were recruited and had blood drawn at their first visits. The prospective cohort was further divided into preeclampsia-positive and preeclampsia-negative groups based on the follow-up results. The following markers were tested using the collected serum samples: soluble fms-like tyrosine kinase-1 (sFlt-1); placental growth factor (PlGF); thrombomodulin (TM); tissue plasminogen activator inhibitor complex (tPAI-C); compliment factors C1q, B, and H; glycosylated fibronectin (GlyFn); pregnancy-associated plasma protein-A2 (PAPP-A2); blood urea nitrogen (BUN); creatinine (Cre); uric acid (UA); and cystatin C (Cysc). Results: A total of 196 women with suspected preeclampsia were recruited with follow-up medical records. Twenty-five percent (n=49) of the recruited subjects developed preeclampsia before delivery, and 75% remained preeclampsia-negative (n=147). The serum levels of sFlt-1, BUN, Cre, UA, Cysc and PAPP-A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia-positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt-1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP-A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP-A2). With the cut-off values obtained from the ROC analyses, the positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions: Although several serum markers were found to be significantly changed with current prospective cohort, their limited predictive values in preeclampsia development posed potential barrier in clinical implementation. Further studies with larger cohort are warranted to further reveal the clinical utilities of the serum markers in preeclampsia prediction.

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