Diagnosing Prosthetic Joint Infections in Patients With Inflammatory Arthritis: A Systematic Literature Review

Mirza, Serene; Richardson, Shawn S.; Kahlenberg, Cynthia A.; Blevins, Jason L.; Lautenbach, Charles; Demetres, Michelle; Martin, Lily; Szymonifka, Jackie; Sculco, Peter K.; Figgie, Mark P.; Goodman, Susan M.

doi:10.1016/j.arth.2019.01.051

Cited by 16 publications

(16 citation statements)

References 30 publications

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“…Therefore, we investigated in ammatory markers of local synovial uid in joints with higher speci city [4]. Based on previous studies, detection time and economic bene ts, we focused on the value of synovial CRP in differentiating chronic PJI [13,14,23,24]. Our study indicated the synovial CRP possess a 93.10% diagnostic speci city and 89.69% diagnostic accuracy in identifying chronic PJI (Table 3).…”

Section: Discussionmentioning

confidence: 94%

Combined Serum and Synovial C-Reactive Protein Tests: An Economical and Efficient Adjunct to the Diagnosis of Chronic Prosthetic Joint Infection

Hai¹,

Qin²,

Wang³

et al. 2021

Preprint

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Background Diagnosis of Periprosthetic joint infection (PJI) is very complex and challenging, especially for chronic PJI. The value of C-reactive protein (CRP) in infectious diseases has been recognized, but the diagnostic value of CRP in chronic PJI is unknown. Our objective was to investigate the effectiveness of synovial CRP in chronic PJI and to determine the optimal combination of serum and synovial CRP in distinguishing chronic PJI from aseptic failure after knee and hip arthroplasties. Methods From January 2018 to December 2019, we prospectively included patients scheduled to have a revision surgery for chronic PJI or aseptic loosening of an implant, in which synovial CRP 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. Results There were no statistically significant differences in demographic data among the 97 cases we eventually included. the synovial CRP levels were significantly higher in the infection group than in the aseptic group (median: 19 mg/l vs. 9.25 mg/l; p = .001). The optimal cut-off value for detecting chronic PJI of synovial CRP was of 7.26 mg/l with a sensitivity of 84.62%, a specificity of 93.10%. The combined model I (Serum CRP > 10.2 mg/l OR SF CRP > 7.2 6 mg/l) had a negative predictive value (NPV) of 96.67%, and a sensitivity of 97.44%. The combined model II (Serum CRP > 10.2 mg/l AND Synovial CRP > 7.26 mg/l) led to a specificity of 1, and a positive predictive value (PPV) of 1. Conclusion The present study demonstrated that the combination of serum and synovial CRP can be used as an adjunct to the diagnosis of chronic PJI.

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Section: Discussionmentioning

confidence: 94%

Combined Serum and Synovial C-Reactive Protein Tests: An Economical and Efficient Adjunct to the Diagnosis of Chronic Prosthetic Joint Infection

Hai¹,

Qin²,

Wang³

et al. 2021

Preprint

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“…A systematic literature review performed by Mirza et al to evaluate the e cacy of synovial biomarkers for diagnosing PJI in IA patients, showed that whilst the sensitivities are high for many serum and synovial tests, speci cities in this patient population are low. 11 They showed that although levels of synovial WBCs, IL-6, IL-8 and serum CRP appear higher in infected patients with IA, there is overlap with those who are not infected. The poor speci city of standard diagnostic tests contributed to the development of our hypothesis that a proportion of IA patients are not infected but are aring.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] However, the diagnosis of PJI in patients with IA is challenging because aseptic RA or SLE ares may mimic PJI both clinically (joint pain, swelling, fever) and diagnostically (elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and synovial leukocytosis). 11 In addition, the currently available diagnostic criteria for diagnosing PJI does not provide guidance on how to differentiate PJI from RA ares and few studies have comprehensively characterized PJI in patients with RA and SLE.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Histological Features of Prosthetic Joint Infections May Differ In Patients With Inflammatory Arthritis and Osteoarthritis

Sculco

Kapadia

Moezinia

et al. 2021

Preprint

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Background: Inflammatory arthritis (IA) patients are at increased risk for prosthetic joint infections (PJI); however, diagnosis is challenging because active IA patients have elevated inflammatory markers that may mimic joint infection and definitive microbiologic diagnosis may be delayed. The objective of this pilot study was to identify the clinical, microbiologic, and histopathologic features of culture positive (CP) and culture negative (CN) total hip (THA) and total knee arthroplasty (TKA) PJI in IA patients and obtain preliminary data to support a definitive study to determine the optimal method for PJI diagnosis in patients with inflammatory arthritis. Methods: A retrospective cohort of THA/TKA PJIs, from 2009 to 2016, were identified using an institutional PJI registry. H&E slides of OA and IA PJI cases matched by age, sex, and culture status were histologically reviewed. Clinical characteristics were evaluated using Fisher’s exact, Chi-Square tests, Students’ t test, and Mann Whitney U test where appropriate.Results: 807 PJI cases were identified including 36 IA and 771 OA. A higher proportion of IA PJI were CN (N=10, 27%) vs. OA PJI (N=109, 14%, p=0.02). IA PJI patients compared to OA patients presented younger (p<0.001), with a higher Charlson Comorbidity Index (p=0.002), had more frequent use of glucocorticoids (p<0.001) and a larger proportion were female (p<0.001). Of 88 PJIs reviewed for histopathology, within the IA cohort, a higher proportion of CP-IA had >10 PMN per HPF (p= 0.003) and met MSIS criteria (p=0.009) but presented with less chronic inflammation (p=0.017).Conclusions: This hypothesis-generating study suggests that culture negative PJI is more frequent in patients with IA than OA. Higher rates of prior PJI, differences in histopathology, and better clinical outcomes suggest biologic differences between CN and CP PJI that should be explored further in a prospective study.

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“…Therefore, we investigated inflammatory markers of local synovial fluid in joints with higher specificity [4]. Based on previous studies, detection time and economic benefits, we focused on the value of synovial CRP in differentiating chronic PJI [14,[23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Combined serum and synovial C-reactive protein tests: a valuable adjunct to the diagnosis of chronic prosthetic joint infection

Wang

Qin

Wang

et al. 2021

BMC Musculoskelet Disord

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Background Diagnosis of periprosthetic joint infection (PJI), especially chronic PJI, is very confusing and challenging. The value of C-reactive protein (CRP) in infectious diseases has been recognized, but the diagnostic value of CRP in chronic PJI is unknown. Our aim was to investigate the diagnostic value of synovial CRP in chronic PJI and to explore the role of combined serum and synovial CRP in distinguishing chronic PJI from aseptic failure after knee and hip arthroplasties. Methods We prospectively enrolled patients scheduled to have a revision surgery for chronic PJI or aseptic loosening from January 2019 to December 2020, in which synovial CRP was additionally measured along with routine preoperative diagnostic serum ((ESR, CRP) and synovial (PMN%) biomarkers. The receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker to determine diagnostic efficacy. Results There were no statistically significant differences between the infection (n = 39) and aseptic (n = 58) groups, including 61 hips and 36 knees. The synovial CRP levels were significantly higher in the infection group than in the aseptic group (median: 9.93 mg/l vs 3.58 mg/l; p < .001). The optimal cut-off value for detecting chronic PJI of Synovial fluid (SF) CRP was of 7.26 mg/l with a sensitivity of 84.62%, a specificity of 93.10%. The combined model I (Serum CRP > 10.2 mg/l OR SF CRP > 7.26 mg/l) had a negative predictive value (NPV) of 96.67%, and a sensitivity of 97.44%. The combined model II (Serum CRP > 10.2 mg/l AND Synovial CRP > 7.26 mg/l) led to a specificity of 1, and a positive predictive value (PPV) of 1. Conclusions The present study demonstrated that the combination of serum and synovial CRP can be used as an adjunct to the diagnosis of chronic PJI.

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Diagnosing Prosthetic Joint Infections in Patients With Inflammatory Arthritis: A Systematic Literature Review

Cited by 16 publications

References 30 publications

Combined Serum and Synovial C-Reactive Protein Tests: An Economical and Efficient Adjunct to the Diagnosis of Chronic Prosthetic Joint Infection

Combined Serum and Synovial C-Reactive Protein Tests: An Economical and Efficient Adjunct to the Diagnosis of Chronic Prosthetic Joint Infection

Clinical and Histological Features of Prosthetic Joint Infections May Differ In Patients With Inflammatory Arthritis and Osteoarthritis

Combined serum and synovial C-reactive protein tests: a valuable adjunct to the diagnosis of chronic prosthetic joint infection

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