The proper timing of second-stage revision in treating periprosthetic knee infection: reliable indicators and risk factors

Fu, Jun; Ni, Ming; Li, Xiang; Chai, Wei; Zhou, Yonggang; Hao, Libo; Chen, Jiying

doi:10.1186/s13018-018-0885-z

Cited by 40 publications

(49 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In North America and East Asia, two-stage exchange arthroplasty is widely applied for chronic PJIs after TJA [3,4]. After removing the infected prosthesis and implanting an antibiotic-loaded spacer in the rst stage, the proper timing of reimplantation is crucial for successful treatment [5]. Currently, there is no "gold standard" to evaluate the eradication of PJI before reimplantation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Jiang

Chai

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background The proper timing of reimplantation is importation to treatment success in two-stage exchange revision. The 2018 International Consensus Meeting suggested that a variation trend toward normalization in serum markers was useful for determining the proper timing of reimplantation. However, the opposite results were found that by previous studies, and the normalization of serum markers was reported to fail to predict infection control. We investigated whether value changes and percent changes in four common serum markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen) can predict persistent infection?Methods A retrospective review of 141 patients treated with two-stage revision from 2014 to 2018 was conducted. The variation trend in serum indicators was evaluated by the percent changes (using values of serum markers prereimplantation divided by values preresection) and value changes (using values of serum markers preresection minus values prereimplantation). Treatment success was defined according to the Delphi-based consensus criteria with a minimum follow-up of 1 year, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in serum markers.Results 22 patients (15.60%) were persistently infected. No significant difference was found in either the value change or percent change in serum markers between reinfection and non-reinfection patients. When predicting persistent infection, the area under the curves (AUC) demonstrated that both percent changes and value changes in serum markers were poor indicators. The AUC of value changes was 0.533 for the CRP, 0.504 for the IL-6, 0.508 for the ESR and 0.586 for fibrinogen when predicted persistent PJI. In addition, the AUC indicated that percent changes in the CRP (0.464), the IL-6 (0.534), the ESR (0.527) and fibrinogen (0.586) were all poor markers.Conclusions We have shown that both value changes and percent changes in serum markers were not sufficiently rigorous to aid in persistent infection diagnosis. The proper timing of reimplantation must therefore take into account various clinical tests rather than the downward trend of serum markers only.

show abstract

Section: Introductionmentioning

confidence: 99%

“…However, the reliability and utility of both indictors has been questioned by several studies. Due to their unclear threshold cutoff levels, the normalization of both markers was reported to fail to predict PJI control [5][6][7]11]. More than the ESR and CRP, several other serum biomarkers have been studied by researchers.…”

Section: Introductionmentioning

confidence: 99%

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Jiang

Chai

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…In North America and East Asia, two-stage exchange arthroplasty is wildly applied to chronic PJIs after TJA [3,4]. After removing the infected prosthesis and implanting an antibiotic-loaded spacer in first stage, the proper timing of reimplantation is crucial for successful treatment [5].So far, there is no gold reference to determine the eradication of PJI before reimplantation. The combination of serum indicators, synovial white cell count (WBC), culture results, intraoperative histology, and clinical symptoms is used extensively to guide the timing of reimplantation.…”

Section: Introductionmentioning

confidence: 99%

“…But the relativity and utility of both indictors was suspected by several researches. In spite of their doubtful threshold cutoff levels, the normalization of both markers was reported failed to predict control of PJI [5][6][7]11].Several other serum biomarkers were studied by researchers. Interleukin-6 (IL-6) was proved to be useful in diagnose PJI [12][13][14], and Hoell et al reported the good utility of IL-6 in predicting failure of reimplantation [15].…”

Section: Introductionmentioning

confidence: 99%

Change in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange ArthroplastyChange in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Jiang¹,

Yang²,

Xu³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundTwo-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in first stage, the proper timing of reimplantation is crucial for successful treatment. So far, there is no gold reference to determine the eradication of PJI before reimplantation. The combination of serum indicators, synovial white cell count (WBC), culture results, intraoperative histology, and clinical symptoms is used extensively to guide the timing of reimplantation. However, the proper timing of reimplantation was ill defined.PurposeWe wonder: (1) the utility of serum indicators, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, when predicted failure of reimplantation; (2) correlation between primary culture results and serum markers’ change.MethodA retrospective review of 226 patients treated with a two-stage exchange arthroplasty from 2014 to 2017 was conducted. PJI was diagnosed by using the Musculoskeletal Infection Society (MSIS) criteria. Serum biomarkers and organisms results at the set of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 year; receiver operator characteristic (ROC) depicted the utility of change in four serum markers when predicted failure.ResultsThe ROC area under the curves (AUC) was 0.543 in CRP, 0.572 in IL-6, 0.621 in ESR, 0.463 in fibrinogen and the combination of them was 0.709 when predicted persistent PJI using value change. The AUC of ROC was 0.521 in CRP, 0.472 in IL-6, 0.413 in ESR, 0.552 in fibrinogen and the combination was 0.630 when determine reimplantation by percent change. No significant association was found between culture results and change in serum markers.ConclusionNeither percent change nor value change in serum makers was proved to be poor markers when predicted persistent PJI, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still tough to diagnose. The combination of clinical symptom, pathology results, synovial fluid analysis and serum markers may improve the utility.

show abstract

“…A definite PJI is present when: questioned by several studies. Due to their unclear threshold cutoff levels, the normalization of both markers was reported to fail predict PJI control [5][6][7]11].Several other serum biomarkers have been studied by researchers. Interleukin-6 (IL-6) was suggested to be useful in diagnosing PJI [12][13][14], and Hoell et al reported the high utility of IL-6 in predicting reimplantation failure [15].…”

Section: Introductionmentioning

confidence: 99%

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Jiang

Yang

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Two-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in the first stage, the proper timing of reimplantation is crucial for successful treatment. To date, there is no gold standard to evaluate the eradication of PJI before reimplantation. A combination of serum indicators, synovial blood white cell (WBC) counts, culture results, intraoperative histology, and clinical symptoms is wildly used to guide the timing of reimplantation. However, the proper timing of reimplantation is not clearly defined. We investigated whether: (1) serum indicators, which included the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, were useful indicators for predicting the failure of reimplantation; and (2) primary culture results were related to serum marker changes? Method A retrospective review of 109 patients treated with two-stage exchange arthroplasty from 2014 to 2017 was conducted. The inclusion criteria included the following: 1. a minimum of a 2-year follow-up or failure of treatment within this period; 2. complete record of serum biomarkers; and 3. met the Musculoskeletal Infection Society criteria (MSIS) when diagnosed PJI. Serum biomarkers and organism results at the onset of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 years, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in four serum markers for predicting failure. Results When predicting persistent PJI, the area under the ROC curves (AUC) demonstrated that both the percent change and value change of serum markers were poor indicators. When comparing exact values of serum markers during reimplantation, the values of CRP and fibrinogen were significant higher in reinfection group. Besides, initial causative organism didn’t influence the normalize of serum markers. Conclusion Either the value change or percent change of serum markers were not useful for determining the timing of reimplantation, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still difficult to diagnose.

show abstract

The proper timing of second-stage revision in treating periprosthetic knee infection: reliable indicators and risk factors

Cited by 40 publications

References 20 publications

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Change in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange ArthroplastyChange in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Contact Info

Product

Resources

About