Periprosthetic Joint Infection Can Cause Abnormal Systemic Coagulation

Saxena, Arjun; Baratz, Michael D.; Austin, Matthew S.; Purtill, James J.; Parvızı, Javad

doi:10.1016/j.arth.2009.10.003

Cited by 14 publications

(16 citation statements)

References 39 publications

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“…Saxena et al [5] first discovered an association between coagulopathy and PJI, and some studies extended the research targeting D-dimer and fibrinogen as potential tools for PJI diagnosis. Circulating D-dimer is the characteristic product of degradation of cross-linked fibrin, and fibrinogen is a protein for blood coagulation produced primarily by hepatocytes, both of which could be assessed easily and conveniently in coagulation measurements.…”

Section: Introductionmentioning

confidence: 99%

Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials

Pan

Liu

et al. 2021

J Orthop Surg Res

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Purpose D-dimer and fibrinogen, both belonging to coagulation parameters, are controversial for the diagnosis of periprosthetic joint infection (PJI). This meta-analysis was conducted to compare their diagnostic accuracies for PJI by synthesizing currently available evidence. Methods Cochrane Library, MEDLINE, Web of Science, and Embase up to March 1, 2020, and other relevant articles were searched. Five hundred and eighty-one articles were identified after initial research, and 11 studies were included finally. No threshold effects were found between studies. The pooled sensitivity, specificity, and positive and negative likelihood ratio were reported to evaluate the diagnostic performance with heterogeneity analysis. Z test statistics was used to analyze the difference of diagnostic performance between D-dimer and fibrinogen. Results The pooled sensitivity, specificity, and positive and negative likelihood ratio of D-dimer for PJI were 0.79 (95% [CI], 0.72–0.85), 0.77 (0.67–0.84), 3.38 (2.21–5.18), and 0.27 (0.18–0.41), respectively. As for fibrinogen, the pooled sensitivity, specificity, and positive and negative likelihood ratio for PJI were 0.75 (0.68–0.80), 0.85 (0.82–0.88), 5.12 (4.22–6.22), and 0.30 (0.23–0.37), respectively. Great heterogeneity was found in studies for D-dimer, and univariate meta-regression analysis revealed that number of involved joints, disease spectrum, comorbidities influencing D-dimer, and sample sources were the source of heterogeneity. Z test found that the pooled specificity of fibrinogen was significantly higher than D-dimer (0.85 ± 0.01 versus 0.77 ± 0.04, p = 0.03). The pooled positive likelihood ratio of fibrinogen was significantly higher than D-dimer (5.12 ± 0.51 versus 3.38 ± 0.74, p = 0.03). Conclusion Based on currently available evidence, the meta-analysis suggests that fibrinogen performs better than D-dimer as a rule-in diagnostic tool for its higher specificity. However, more prospective trials with larger size are still needed to provide further confirmation. Trial registration This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews), and the registering number was CRD42020177176.

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Section: Introductionmentioning

confidence: 99%

Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials

Pan

Liu

et al. 2021

J Orthop Surg Res

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“…Severe PJI associated with sepsis can induce disseminated intravascular coagulopathy. Less severe PJI can also cause abnormal systemic coagulation problem [12]. In patients who have medical morbidities such as liver cirrhosis or coagulation abnormality, any measure to decrease the operation time and blood loss will be beneficial for the treatment of PJI [12–14].…”

Section: Discussionmentioning

confidence: 99%

“…Less severe PJI can also cause abnormal systemic coagulation problem [12]. In patients who have medical morbidities such as liver cirrhosis or coagulation abnormality, any measure to decrease the operation time and blood loss will be beneficial for the treatment of PJI [12–14]. Unfortunately, a pre-fabricated ready-to-use antibiotic-loaded cement spacer is not popular on the market because it is only available in some countries and the choice of antibiotics needs to be patient-specific according to the culture sensitivity results [4–6].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Storage Temperature on the Antibiotic Release of Vancomycin-Loaded Polymethylmethacrylate

Chen

Chang

Hsieh

et al. 2013

The Scientific World Journal

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Periprosthetic joint infection is devastating and increases medical expenditure and socioeconomic burden. Antibiotic-loaded cement spacer is useful in the interim period before the reimplantation surgery. Prefabricated antibiotic-loaded cement spacers can decrease operation time but have been limitedly used clinically. In the literature, there is no clear recommendation on the storage temperature for the prefabricated cement spacers. We used an in vitro model to analyze whether the storage temperature at 25°C, 4°C, or −20°C for 2 weeks or 3 months could affect the release of vancomycin from the cement. We found that the storage temperature and time had no significant effects on the pattern and amount of vancomycin release. The patterns of vancomycin release from the cement stored at different temperatures were similar with an abrupt release in the first 3 days and steadily declined in the following period. This study provides a preliminary result to justify the storage of fabricating antibiotic-loaded cement spacer sterilely packed at room temperature. Further studies to examine the effects of storage temperature on the mechanical strength and the release pattern of other antibiotics should be done to provide more evidence to support the clinical use of prefabricated ready-to-use antibiotic-loaded cement spacer.

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“…The pathogens of PJI are known to impair their hosts by endotoxin and exotoxin which can stimulate immune cells to produce various cytokines such as IL-6, TNF and IL-6 [5][6][7]. These secreted cytokines may disrupt normal coagulation cascade and cause abnormal coagulation pro le in PJI patients.…”

Section: Introductionmentioning

confidence: 99%

“…It suggests that PJI patients suffer from abnormal coagulation. The subclinical abnormal coagulation can increase the risk of epidural hematoma formation and impair incision healing after surgery theoretically [6][7][8]. However, a review of literatures suggests that the studies about the relationship between coagulation system and the clinical outcomes of PJI are limited [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The Change of Coagulation Profile in Two-staged Arthroplasty for Periprosthetic Joint Infection Patients：A Retrospective Cohort Study

Li²,

et al. 2021

Preprint

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Aims：Periprosthetic joint infection (PJI) a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate 1) the change of coagulation profile in two-staged arthroplasty patients 2) the relationship between coagulation profile and the outcomes of reimplantation. Method: Between 2011 January and 2018 December, a total of 202 PJI patients who were performed with two-staged arthroplasty were included in this study initially. They were followed up at least 2 years and corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points 1) preresection and 2) preimplantation. Then, the difference of coagulation profile between preresection and preimplantation was evaluated. Besides, receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of coagulation profile and the change of coagulation profile for predicting persistent infection before reimplantation. Results: The levels of APTT, INR, platelet count, PT, TT and plasma fibrinogen before spacer implantation were significantly higher than that before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95%CI:(0.511,0.823) and 0.667 (95%CI: (0.526,0.808)), respectively.Conclusion: The coagulation profile before preresection is different from that before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of Evidence: level III, diagnostic study

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Periprosthetic Joint Infection Can Cause Abnormal Systemic Coagulation

Cited by 14 publications

References 39 publications

Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials

Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials

The Influence of Storage Temperature on the Antibiotic Release of Vancomycin-Loaded Polymethylmethacrylate

The Change of Coagulation Profile in Two-staged Arthroplasty for Periprosthetic Joint Infection Patients：A Retrospective Cohort Study

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