Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Li, Cheng; Renz, Nora; Trampuž, Andrej; Ojeda-Thies, Cristina

doi:10.1007/s00264-019-04426-7

Cited by 92 publications

(68 citation statements)

References 81 publications

(105 reference statements)

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“…Systemic inflammation markers and synovial fluid biomarkers have been a hot research topic in recent years [2,3]. Compared with blood tests, synovial fluid tests are more dependent on doctors' personal operational experience; some test results were decided by the tester's subjective judgement, and the procedures of joint aspiration can easily affect the final result [4][5][6][7]. Therefore, blood tests may be easier to use, more stable, more cost-effective and easier to popularize for diagnosing PJI.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Margaryan

Ojeda-Thies

et al. 2020

Preprint

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Background The purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI). Methods A systematic search and screen of relevant studies was performed in the PubMed, Web of Science and Embase databases using the following medical subject headings (MeSH) or keywords: “arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint”, “infection or infectious or infected”, and “D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products”. Then, the data were analysed and processed by Meta-Disc software. Results A total of 7 studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were 0.75 (95% confidence interval [CI]: 0.70 to 0.79), 0.69 (95% CI: 0.66 to 0.72), 3.01 (95% CI: 1.84 to 4.93), 0.32 (95% CI: 0.19 to 0.53) and 10.20 (95% CI: 3.63 to 28.64), respectively. Subgroup analyses showed that use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI (0.86, 0.84 vs. 0.67, 0.60, respectively). Conclusion Serum D-dimer had a better diagnostic value than plasma D-dimer for the diagnosis of PJI.

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Margaryan

Ojeda-Thies

et al. 2020

Preprint

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“…First, 2 of the included studies only had 11 infection cases [4,20], and the small sample size potentially influenced the overall results. Second, although the diagnostic standard was always used for identifying infection cases, the use of different diagnostic standards to estimate the value of diagnostic tools resulted in different sensitivity and specificity values [31]. Third, in the antibiotic subgroup, we found that the combination of serum testing without antibiotic therapy further improved diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 84%

Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

Trampuž¹,

Li²,

Thies³

et al. 2020

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Background: Because there is no single gold-standard method for the diagnosis of periprosthetic joint infection (PJI), the combination of valuable methods to evaluate infection seems to achieve a better diagnostic result. The objective of the present study was to evaluate the diagnostic value of serum interleukin (IL)-6 and C-reactive protein (CRP) for the diagnosis of PJI.Methods: PubMed, Embase, and the Web of Science databases were searched for articles describing PJI diagnosis using serum IL-6 and CRP published between January 1990 and December 2019.Results: Eight studies were included in the meta-analysis. The pooled sensitivity was 0.79 (95% confidence interval [CI]: 0.73 to 0.83) for the combined method (serum IL-6 and CRP), 0.87 (95% CI: 0.82 to 0.91) for IL-6 and 0.83 (95% CI: 0.78 to 0.87) for CRP . The pooled specificity was 0.92 (95% CI: 0.89 to 0.95) for the combined method, 0.85 (95% CI: 0.81 to 0.88) for IL-6, and 0.83 (95% CI: 0.79 to 0.87) for CRP. The combined method had the highest value for the area under the curve (0.9688), followed by IL-6 (0.9259) and CRP (0.9139). Subgroup analyses showed that restricting antibiotic treatment before sample collection may improve specificity.Conclusion: The combination of serum IL-6 and CRP was a reliable tool for the diagnosis of PJI, and it had a better diagnostic accuracy than testing with a single marker, especially when samples were collected without antibiotic therapy. Additional research is needed.

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“…First, two of the included studies only had 11 cases of infection [4,23], and the small sample size potentially affected overall results. Second, although the diagnostic standard was always used to identify cases of infection, the use of different diagnostic standards to estimate the value of diagnostic tools resulted in different sensitivity and specificity values [34]. Third, based on the current publication, two studies showed that the combined method may improve diagnostic results compared to single use in low virulence infections [9,23].…”

Section: Discussionmentioning

confidence: 95%

Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

Thies

et al. 2020

J Orthop Surg Res

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Background Because there is no single gold standard method for the diagnosis of periprosthetic joint infection (PJI), the combination of valuable methods to evaluate infection appears to achieve a better diagnostic result. The objective of the present study was to evaluate the diagnostic value of serum interleukin (IL)-6 and C-reactive protein (CRP) for the diagnosis of PJI. Methods PubMed, Embase, and the Web of Science databases were searched for articles describing PJI diagnosis using serum IL-6 and CRP published between January 1990 and December 2019. Results Eight studies were included in the meta-analysis. The pooled sensitivity was 0.84 (95% confidence interval [CI], 0.80−0.88) for the combined method (serum IL-6 and CRP) in series and parallel approaches, 0.87 (95% CI, 0.82−0.90) for IL-6, and 0.84 (95% CI, 0.79−0.88) for CRP. The pooled specificity was 0.85 (95% CI, 0.82−0.88) for the combined method, 0.83 (95% CI, 0.79−0.87) for IL-6, and 0.83 (95% CI, 0.79−0.87) for CRP. The combined method had the highest value for the area under the curve (0.9453), followed by IL-6 (0.9237) and CRP (0.9074). Subgroup analyses showed that the sensitivity of the combined method in parallel tests was higher than that in IL-6 or CRP (94% vs. 89% and 84%, respectively). Serial testing of the combined method showed increased specificity compared to a single indicator (96% vs. 83% and 80%). Conclusion The combination of serum IL-6 and CRP was a reliable tool for the diagnosis of periprosthetic hip and knee infection, demonstrating a better diagnostic accuracy than single marker analysis.

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Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Cited by 92 publications

References 81 publications

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

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