Serological markers can lead to false negative diagnoses of periprosthetic infections following total knee arthroplasty

Johnson, Aaron J.; Zywiel, Michael G.; Stroh, Alex D; Marker, David R.; Mont, Michael A.

doi:10.1007/s00264-010-1175-5

Cited by 58 publications

(35 citation statements)

References 21 publications

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“…This may suggest that the cutoff point of synovial CRP analysis depends on the assay rather than being an absolute value [33]. Nevertheless, because there is still some overlap in CRP values between septic and aseptic cases (Table 2), PJI should not be excluded on the basis of serum or synovial CRP results alone [18,33].…”

Section: Discussionmentioning

confidence: 99%

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Tetreault

Wetters

Moric

et al. 2014

Clin Orthop Relat Res

100

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Background Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing periprosthetic joint infection (PJI). Questions/purposes We aimed to (1) determine if there is a correlation between serum and synovial CRP values, (2) establish cutoff values for diagnosing infection based on serum and synovial CRP, and (3) compare the utility of measuring CRP in synovial fluid versus serum for the diagnosis of PJI using standard assay equipment available at most hospitals. Methods Between February 2011 and March 2012, we invited all 150 patients scheduled for revision TKA (84) or THA (66) to participate in this prospective study, of whom 100% agreed. Data ultimately were missing for 31 patients, leaving 60 patients undergoing revision TKA and 59 undergoing revision THA (71% and 89% of the original group, respectively) for whom CRP level was measured in serum and synovial fluid samples. Patients were deemed to have a PJI (32) or no infection (87) using Musculoskeletal Infection Society criteria. Serum and synovial CRP levels were assayed using the same immunospectrophotometer and the correlation coefficient was calculated. Receiver operating characteristic curve analyses were performed to compare utility in diagnosing PJI, which included area under the curve, diagnostic threshold, and test sensitivity, specificity, predictive values, and accuracy. In 22 of 150 patients (14.7%), synovial CRP could not be measured because the sample was too viscous or hemolyzed. Results In the analyzed 119 samples, there was a strong correlation (r = 0.76; p \ 0.001) between synovial and serum CRP. The area under the curve was 0.90 both for the synovial fluid (95% CI, 0.82-0.97) and serum (95% CI, 0.84-0.96) CRP assays. The diagnostic thresholds were 6.6 mg/L for synovial fluid and 11.2 mg/L for serum. Sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were similar for synovial fluid and serum assays. Conclusions Although recent studies have suggested a superiority of synovial fluid CRP over serum CRP for the diagnosis of PJI, we found that measurement of CRP in synovial fluid rather than serum using readily available

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Section: Discussionmentioning

confidence: 99%

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Tetreault

Wetters

Moric

et al. 2014

Clin Orthop Relat Res

100

View full text Add to dashboard Cite

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“…Since CRP and ESR showed only low specificity in the work of Johnson et al [9], we didn't look for the effect of these variables.…”

Section: Methodsmentioning

confidence: 99%

Periprosthetic joint infection—effect on quality of life

Helwig

Morlock

Oberst

et al. 2014

International Orthopaedics (SICOT)

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Purpose Relatively little is known about the extent to which periprosthetic joint infections (PJI) affect the patient's longterm quality of life (QoL). Our study aim was to assess the effect of a periprosthetic infection on our patients' QoL. Methods We collected data retrospectively of patients who had undergone surgery in our institution between 2006 and 2011. To capture their overall QoL, we telephoned the patients who could be reached and asked them the questions on the SF-12 questionnaire. Results In 84 patients (53 male, 31 female, 43 TKA and 41 THA), 88 % of the hip infections and 62 % of the knee infections had been successfully treated. The hip infections' cure rate was significantly higher than that of the knee joint infections.The average SF-12 score was 36.2 points on the physical scale and 52 on the mental scale. The difference in QoL between patients with and without successful infection therapy was not significant, nor did the site of the infection (knee or hip) influence QoL significantly.Comparison of our patients' QoL data to that from the general population revealed a significant difference in the physical scale but not the mental scale. Conclusion From these results QoL is substantially reduced after a prosthetic infection. We did however observe that postGirdelstone procedure patients or those with an arthrodesis attained an acceptable QoL, and that those methods remain therapeutic alternatives as far as patient-perceived QoL is concerned.

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“…The differential diagnostics between a septic condition or an aseptic loosening remains difficult [9]. With a suspected PJI, surgical eradication of the pathogen must be combined with an effective and targeted antimicrobial therapy.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Wimmer

Randau

Petersdorf

et al. 2013

International Orthopaedics (SICOT)

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Purpose Current concepts in the treatment of prosthetic joint infections include prosthetic retention and exchange strategies according to published recommendations. A useful algorithm should fit for each type of prosthetic joint infection, even the most complicated situations. We present the outcome of 147 patients with prosthetic joint infections of the hip or the knee joint in an unselected population in clinical routine. Methods Between November 2006 and November 2009, 147 consecutive patients with prosthetic joint infections of the hip or knee were treated according to an algorithm based on the concept published by Zimmerli et al. in 2004. Causative organism, duration of infection, patient comorbidities, surgical treatment, antibiotic treatment, and outcome of treatment were analysed retrospectively. According to the criteria duration of infection, stability of prosthesis, local and systemic risk factors, and susceptibility of the causative pathogen, patients were treated either with debridement and retention or a longinterval two-stage procedure. Results A pathogen could be detected in 82.8 % of the patients, gram-positive cocci being most common. Twentyseven patients were treated with debridement and retention and 120 were treated with a two-stage procedure. In 68 cases difficult-to-treat pathogens could be detected, a polymicrobial infection was found in 51 patients. Definitely free of infection were 71.6 % after a two-stage procedure, and 70.4 % after debridement and retention. Conclusions Our data indicates that the applied algorithm is suitable to be applied as a day-to-day routine, and we confirmed that published results from the literature can be reproduced in an inhomogeneous patient cohort.

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Serological markers can lead to false negative diagnoses of periprosthetic infections following total knee arthroplasty

Cited by 58 publications

References 21 publications

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Periprosthetic joint infection—effect on quality of life

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

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