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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(06): e917-e923
DOI: 10.1055/s-0043-1776907
Artigo Original
Joelho

Accuracy of Serological Markers, Synovial Fluid, Microbiological Culture, and Histopathological Examination for Diagnosing Periprosthetic Knee Infection

Artikel in mehreren Sprachen: português | English
Alan de Paula Mozella 
1   Médico ortopedista e traumatologista do Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Hugo Alexandre de Araújo Barros Cobra 
1   Médico ortopedista e traumatologista do Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Sandra Tie Nishibe Minamoto 
1   Médico ortopedista e traumatologista do Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Rodrigo Salim 
2   Médico ortopedista e traumatologista do Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP-RP), Ribeirão Preto, São Paulo, Brasil
,
Ana Carolina Leal 
3   Pesquisadora da Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
› Institutsangaben

Financial Support This study received no financial support from public, commercial, or not-for-profit sources.
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Abstract

Objective This study assessed the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of serological tests, synovial fluid markers, microbiological tissue culture, and histopathological examination of the periprosthetic membrane in diagnosing periprosthetic knee infection.

Methods This study is prospective, and it includes patients undergoing total knee arthroplasty revision surgery from November 2019 to December 2021. The analysis consisted of serological tests (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and D-dimer), synovial fluid markers (leukocyte and polymorphonuclear cell counts), periprosthetic tissue culture, and histopathological examination of the periprosthetic membrane of all patients.

Results Sixty-two patients had periprosthetic joint infection (PJI) according to the 2018 International Consensus Meeting criteria (infection group), while 22 subjects had no infection. ESR sensitivity and specificity were 83.6% and 45.4%, respectively. CRP sensitivity and specificity were 64.5% and 100%, whereas D-dimer sensitivity and specificity were 78.9% and 25%, respectively. Leukocyte count sensitivity and specificity were 75.6% and 100%, polymorphonuclear cell count sensitivity and specificity were 33% and 100%, respectively. Periprosthetic tissue culture sensitivity and specificity culture were, respectively, 77.4% and 100%. Histopathological examination sensitivity and specificity were 43.7% and 100%, respectively.

Conclusions In our study, the total blood cell count in synovial fluid and microbiological cultures of periprosthetic tissues were the most accurate tests for PJI diagnosis. In contrast, polymorphonuclear cell percentage was the least accurate test for PJI diagnosis.

Keywords

arthroplasty, replacement, knee - postoperative complications - periprosthetic infection - biomarkers

Study developed at the Knee Surgery Center, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.




Publikationsverlauf

Eingereicht: 29. August 2022

Angenommen: 18. Januar 2023

Artikel online veröffentlicht:
08. Dezember 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Fuchs M, Trampuz A, Kirschbaum S, Winkler T, Sass FA. Soluble Pecam-1 as a Biomarker in Periprosthetic Joint Infection. J Clin Med 2021; 10 (04) 612
    CrossrefPubMedSuche in Google Scholar
  • 2 McNally M, Sousa R, Wouthuyzen-Bakker M. et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J 2021; 103-B (01) 18-25
    CrossrefPubMedSuche in Google Scholar
  • 3 Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev 2019; 4 (07) 482-494
    Suche in Google Scholar
  • 4 Li C, Renz N, Trampuz A, Ojeda-Thies C. Twenty common errors in the diagnosis and treatment of periprosthetic joint infection. Int Orthop 2020; 44 (01) 3-14
    CrossrefPubMedSuche in Google Scholar
  • 5 Parvizi J, Tan TL, Goswami K. et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty 2018; 33 (05) 1309-1314.e2
    Suche in Google Scholar
  • 6 Villa JM, Pannu TS, Piuzzi N, Riesgo AM, Higuera CA. Evolution of Diagnostic Definitions for Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty. J Arthroplasty 2020; 35 (3S): S9-S13
    CrossrefPubMedSuche in Google Scholar
  • 7 Schwarz EM, Parvizi J, Gehrke T. et al. 2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions. J Orthop Res 2019; 37 (05) 997-1006
    CrossrefPubMedSuche in Google Scholar
  • 8 Yan CH, Arciola CR, Soriano A, Levin LS, Bauer TW, Parvizi J. Team Approach: The Management of Infection After Total Knee Replacement. JBJS Rev 2018; 6 (04) e9
    CrossrefPubMedSuche in Google Scholar
  • 9 Wasterlain AS, Goswami K, Ghasemi SA, Parvizi J. Diagnosis of Periprosthetic Infection: Recent Developments. J Bone Joint Surg Am 2020; 102 (15) 1366-1375
    CrossrefPubMedSuche in Google Scholar
  • 10 Carli AV, Abdelbary H, Ahmadzai N. et al. Diagnostic Accuracy of Serum, Synovial, and Tissue Testing for Chronic Periprosthetic Joint Infection After Hip and Knee Replacements: A Systematic Review. J Bone Joint Surg Am 2019; 101 (07) 635-649
    CrossrefPubMedSuche in Google Scholar
  • 11 Iorio R, Viglietta E, Mazza D. et al. Accuracy and Cost-Effectivenss of a Novel Method for Alpha Defensins Measurement in the Diagnosis of Periprosthetic Joint Infections. J Arthroplasty 2021; 36 (09) 3275-3281
    CrossrefPubMedSuche in Google Scholar
  • 12 Tubb CC, Polkowksi GG, Krause B. Diagnosis and Prevention of Periprosthetic Joint Infections. J Am Acad Orthop Surg 2020; 28 (08) e340-e348
    CrossrefPubMedSuche in Google Scholar
  • 13 Sharma K, Ivy M, Block DR. et al. Comparative analysis of 23 synovial fluid biomarkers for hip and knee periprosthetic joint infection detection. J Orthop Res 2020; 38 (12) 2664-2674
    CrossrefPubMedSuche in Google Scholar
  • 14 Kheir MM, Tan TL, Shohat N, Foltz C, Parvizi J. Routine Diagnostic Tests for Periprosthetic Joint Infection Demonstrate a High False-Negative Rate and Are Influenced by the Infecting Organism. J Bone Joint Surg Am 2018; 100 (23) 2057-2065
    CrossrefPubMedSuche in Google Scholar
  • 15 Uvodich ME, Dugdale EM, Osmon DR, Pagnano MW, Berry DJ, Abdel MP. The effectiveness of laboratory tests to predict early postoperative periprosthetic infection after total knee arthroplasty. Bone Joint J 2021; 103-B (6, Supple A) 177-184
    CrossrefPubMedSuche in Google Scholar
  • 16 Pérez-Prieto D, Portillo ME, Puig-Verdié L. et al. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop 2017; 41 (07) 1315-1319
    CrossrefPubMedSuche in Google Scholar
  • 17 Palan J, Nolan C, Sarantos K, Westerman R, King R, Foguet P. Culture-negative periprosthetic joint infections. EFORT Open Rev 2019; 4 (10) 585-594
    CrossrefPubMedSuche in Google Scholar
  • 18 Shahi A, Kheir MM, Tarabichi M, Hosseinzadeh HRS, Tan TL, Parvizi J. Serum D-Dimer Test Is Promising for the Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation. J Bone Joint Surg Am 2017; 99 (17) 1419-1427
    CrossrefPubMedSuche in Google Scholar
  • 19 Li R, Shao HY, Hao LB. et al. Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection: A Multicenter Retrospective Study. J Bone Joint Surg Am 2019; 101 (07) 613-619
    CrossrefPubMedSuche in Google Scholar
  • 20 Pan L, Wu H, Liu H, Yang X, Meng Z, Cao Y. Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials. J Orthop Surg Res 2021; 16 (01) 30
    CrossrefPubMedSuche in Google Scholar
  • 21 Xu H, Xie J, Huang Q, Lei Y, Zhang S, Pei F. Plasma Fibrin Degradation Product and D-Dimer Are of Limited Value for Diagnosing Periprosthetic Joint Infection. J Arthroplasty 2019; 34 (10) 2454-2460
    CrossrefPubMedSuche in Google Scholar
  • 22 Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2016; 387 (10016): 386-394
    CrossrefPubMedSuche in Google Scholar
  • 23 Chisari E, Parvizi J. Accuracy of blood-tests and synovial fluid-tests in the diagnosis of periprosthetic joint infections. Expert Rev Anti Infect Ther 2020; 18 (11) 1135-1142
    CrossrefPubMedSuche in Google Scholar
  • 24 Balato G, Franceschini V, Ascione T, Lamberti A, Balboni F, Baldini A. Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections. Arch Orthop Trauma Surg 2018; 138 (02) 165-171
    CrossrefPubMedSuche in Google Scholar
  • 25 Filep JG, Ariel A. Neutrophil heterogeneity and fate in inflamed tissues: implications for the resolution of inflammation. Am J Physiol Cell Physiol 2020; 319 (03) C510-C532
    CrossrefPubMedSuche in Google Scholar
  • 26 Deniset JF, Kubes P. Neutrophil heterogeneity: Bona fide subsets or polarization states?. J Leukoc Biol 2018; 103 (05) 829-838
    CrossrefPubMedSuche in Google Scholar
  • 27 Muñoz-Mahamud E, Molinas I, Lozano L. et al. Usefulness of Culturing the Periprosthetic Membrane or Neosynovium for the Diagnosis of Infection During Hip and Knee Revision Arthroplasty. J Am Acad Orthop Surg 2018; 26 (20) e442-e447
    CrossrefPubMedSuche in Google Scholar