Inflammatory response in 85 patients with loosened hip prostheses: A prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening

Abstract

Background The most common complications of prosthetic hip joints are aseptic mechanical failure and infection. Delayed low-grade infections are seen most often, and they are also most difficult to distinguish from aseptic mechanical failures.Methods We conducted a prospective study to compare inflammatory markers in patients diagnosed with aseptic or septic prosthetic loosening. The diagnostic criteria were based on the decisions of experienced orthopedic surgeons and microbiological analysis of periprosthetic tissue samples taken perioperatively.Results Coagulase-negative staphylococci were the commonest pathogens in the infected patients. Pre-or perioperative elevation of C-reactive protein and erythrocyte sedimentation rate were significantly greater in the infection group, as were white blood cell count and levels of cytokines in synovial fluid. The patterns of infiltration of inflammatory cells in periprosthetic tissue were also significantly different between the groups.Interpretation A combination of clinical judgment and multiple tissue samples constitutes a good platform for distinguishing between septic and aseptic loosening of prostheses. Moreover, the combined use of several laboratory and histopathological markers of inflammation, especially infiltration of polymorphonuclear cells, further helps the diagnosis.

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

“…Gollwitzer et al [9] evaluated 10 markers in their ability to specifically distinguish aseptic loosening from staphylococcal infections, and IL-1b had a sensitivity of 0.67, whereas IL-6 had a sensitivity of 0.6. Nilsdotter-Augustinsson et al [12] attempted to differentiate septic from aseptic loosening with the use of 11 inflammatory markers; IL-1b and IL-6 had sensitivities of 0.59 and 0.69, respectively. Despite the promising clinical applicability that synovial fluid cytokines may provide for the diagnosis of PJI, there is still a lack of large multiinstitutional studies to validate this method.…”

“…The four synovial fluid biomarkers with the highest patient numbers evaluated for this purpose were CRP [5,6,13,15,16,18,20,21], IL-6 [4,6,[9][10][11][12]19], adefensin [1,5,6], and IL-1b [4,6,9,12], respectively. Although a-defensin clearly shows the highest diagnostic accuracy, it has only been evaluated in three studies to the date of our review, two of which emanate from the same group of researchers.…”

“…Several studies have reported the clinical utility of synovial fluid inflammatory biomarkers in diagnosing PJI [4,6,[9][10][11][12]17]. Although inflammatory responses can also be elicited by aseptic conditions, Deirmengian et al [7] demonstrated that a specific genomic response by neutrophils is associated with an infectious etiology.…”

“…Thus, the assessment of certain inflammatory biomarkers within the synovial fluid has proven to be not only sensitive, but also highly specific to PJI. Synovial fluid biomarkers shown to have the highest diagnostic accuracy include a-defensin, Creactive protein (CRP) and interleukins (IL)-1a, IL-1b, IL-6, and IL-8 [4,6,[9][10][11][12]. Nevertheless, no formal systematic review has been conducted on this topic.…”

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

“…Serum ESR and CRP are useful screening tools for the diagnosis of PJI after TKA and THA in the chronic [9,11,12,20,22,24,25,28,29,31,32] and acute settings [1,36] as well as in the presence of inflammatory arthritis [5]. However, the use of these tests in the presence of ALTR and corrosion is unclear with concerns over falsely positive results [6,7,10,13,21,34].…”