Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Abstract

Background A periprosthetic joint infection is one of the most challenging complications associated with THA and TKA. In the diagnostic process for detecting a periprosthetic joint infection, one of the most important steps is analysis of laboratory infection biomarkers. Questions/purposes We investigated the sensitivity and specificity of the biomarkers procalcitonin, interleukin 6 (IL-6), and interferon a (IFN-a) as compared with conventional biomarkers (C-reactive protein [CRP], leukocyte level) for a periprosthetic joint infection associated with revision arthroplasties. Methods We prospectively included and analyzed 84 patients (124 revision arthroplasties). The blood parameters of interest were procalcitonin, IL-6, IFN-a, leukocyte level, and CRP. Samples were taken preoperatively and on the first, third, and seventh postoperative days. The sensitivity and specificity of these biomarkers then were calculated. Results Considering the preoperative values of 84 patients (124 operations), procalcitonin, IL-6, CRP, and leukocyte level correlated with periprosthetic joint infection, whereas IFN-a did not. A procalcitonin cut-off level of 0.35 ng/mL revealed a sensitivity of 80% and specificity of 37%. An IL-6 cut-off level of 2.55 pg/mL had a sensitivity of 92% and specificity of 59%. Conclusions In this study procalcitonin and IL-6 were helpful for detecting periprosthetic joint infections in revision arthroplasties, although CRP generally was superior. Procalcitonin and IL-6 may be considered adjuvant tests when the diagnosis of a periprosthetic joint infection is in doubt. This study showed, in addition to conventional biomarkers such as CRP and leukocyte level, procalcitonin and IL-6 were helpful for detecting infections associated with revision arthroplasties.

Perspectives: How to Deal with Fever (38 °C) After Arthroplasty: The Infectivologist’s Point of View

“…Unlike CRP and white blood cell count, procalcitonin values were signifi cantly higher in 45 patients with infection compared with 58 uninfected cases on the day of fever onset, day 1 and day 3. Similar data supporting procalcitonin use in association with other biomarkers such as IL-6 and CRP are reported by Glehr et al ( 2013 ) and by Bottner et al ( 2007 ) in smaller studies investigating febrile patients.…”

Advancements in Diagnosing Periprosthetic Joint Infections after Total Hip and Knee Arthroplasty

“…Procalcitonin has also been used as a marker of systemic infection, but its role in the diagnosis of a local infection such as PJI is limited because the threshold of procalcitonin in patients with local infection overlaps significantly with its normal range (low specificity) [13, 14, 21]. Nevertheless, recent studies did not confirm that IL-6 and procalcitonin outperform conventional blood biomarkers for diagnosis of PJI [22]. …”

Infection post-total knee replacement: current concepts

“…One study included 124 revision arthroplasty procedures and found that procalcitonin, interleukin 6, and interferon α were not superior to CRP [40]. The other study utilized enzyme-linked immunosorbent assay (ELISA) to measure the levels of antimicrobial peptides such as human β-defensin 2, human β-defensin 3, and cathelicidin LL-37 as well as inflammatory cytokines such as interleukin (IL)-1β, IL-4, IL-6, IL-17A, interferon-γ, and tumor necrosis factor (TNF)-α in 15 patients with PJI and 20 patients with aseptic revision [28].…”