Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection

Abstract

BackgroundEarly detection followed by prompt intervention is essential for the treatment of periprosthetic joint infection (PJI). D-dimer, a fibrin degradation product, characteristically changes rapidly during early postoperative period and has a short half-life. The aim of this prospective study was to measure postoperative change of D-dimer level after joint arthroplasty in conjunction with ESR and CRP.MethodsESR, CRP, and D-dimer levels were measured on the day before surgery, postoperative days 1, 2, 3, and 5 and weeks 2 and 6 in 65 patients who underwent elective primary total hip arthroplasty (38 hips in 38 patients) or total knee arthroplasty (27 knees in 27 patients). We compared perioperative changes of the three biomarkers.ResultsESR level was elevated from postoperative day 1 and reached a peak level of 45 mm/h at postoperative day 5. The elevation persisted until postoperative week 6. CRP level was elevated from postoperative day 1 and reached a peak level of 10 mg/dl between postoperative day 2 and day 3. The CRP level was decreased to the normal level around postoperative week 2. D-dimer level was sharply elevated and peaked to 4.5 μg/dl at postoperative day 1. At postoperative day 2, it decreased to baseline level. After then, it slowly elevated again and reached a second peak at postoperative week 2.ConclusionD-dimer showed a more rapid rise and fall than ESR and CRP in very early postoperative period. The D-dimer test might be effective in early detection of PJI, if combined with levels of ESR and CRP. The postoperative change of D-dimer in our study can serve as a baseline for early diagnosis of PJI.

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

“…In a prospective, observational clinical study, Ribera et al [33] found that septic joint disease is associated with a marked increase in synovial D-dimer concentration within the affected joint, and synovial D-dimer level may be considered a complementary diagnostic marker of septic joint disease. It has been reported that D-dimer sharply increases up to double levels and decrease to the baseline level within a short time during early postoperative period of TJA, and this dynamic change is more rapid than ESR and CRP [34,35]. Shahi et al [13] found that the sensitivity, specificity, and the cutoff value of plasma D-dimer were 89%, 93%, and 850 ng/mL, respectively, for detecting PJI.…”

Serum D-Dimer in the Diagnosis of Periprosthetic Knee Infection: Where Are We Today?

“…7 When considering D-dimer levels for the diagnosis of PJI, particular attention should be paid to the natural progress of these levels during the perioperative period. 16 Total joint arthroplasty leads to a state of increased inflammation and coagulation and biomarkers of inflammation such as CRP, ESR, and D-dimer have been shown to have variable values during the postoperative period. Serum D-dimer sharply increases after surgery, reaches a peak at postoperative day 1 (1st peak), then abruptly decreases on day 2, after this it rises slowly till the second week after surgery (2nd peak), and finally, it decreases getting close to normal values at the 6th postoperative week.…”

“…The natural curve of D-dimer is invaluable for the diagnosis of PJI based on abnormal D-dimer levels. 16 Despite all the extraordinary efforts by the orthopaedic community, the diagnosis of PJI remains a challenge. During the last decade, a plethora of markers [17][18][19] have been evaluated for the diagnosis of PJI with recent evidence suggesting that the use of D-dimer might be valuable for that purpose.…”

Plasma Fibrinogen is a good new auxiliary diagnostic marker for periprosthetic joint infection

“…Despite coagulation markers such as Platelet Count and Mean Platelet Volume ratio [22], D-Dimer [23] and plasma Fibrinogen [24] have been used in in ammation and infection diseases diagnosis [10,11], the role of these coagulation markers in PJI diagnosis is still unknow. Although the role of D-Dimer [12][13][14] plasma Fibrinogen [16], Platelet Count and Mean Platelet Volume ratio [15] were evaluated in PJI diagnosis, and D-dimer > 1170 ng/m [14], PC/MPV > 31.70 [15] and FIB > 4.01 µg/mL [16] were recommend as the optimum threshold value for the PJI diagnosis, no subsequent studies were published thereafter.…”

“…Recently, the sensitivity and speci city of several coagulation markers including D-Dimer [12][13][14] Platelet Count and Mean Platelet Volume ratio [15] and plasma Fibrinogen [16] were compared with CRP and ESR in PJI diagnosis, and these studies showed that these commonly used coagulation markers can be selected for PJI diagnosis. However, no subsequent studies were published thereafter.…”