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Published on: December 3, 2017
Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection
Martin A Buttaro1, Gabriel Martorell2, Mauricio Quinteros2
1Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosí 4247, C1199ACK, Buenos Aires, Argentina. martin.buttaro@hospitalitaliano.org.ar.
Background:
Synovial quantification of C-reactive protein (SCRP) has been recently published with high sensitivity and specificity in the diagnosis of periprosthetic joint infection. However, to our knowledge, no studies have compared the use of this test with intraoperative frozen section, which is considered by many to be the best intraoperative test now available.
Questions/Purposes:
We asked whether intraoperative SCRP could lead to comparable sensitivity, specificity, and predictive values as intraoperative frozen section in revision total hip arthroplasty.
Methods:
A prospective study was performed including 76 patients who underwent hip revision for any cause. SCRP quantification (using 9.5 mg/L as denoting infection) and the analysis of frozen section of intraoperative samples (five or more polymorphonuclear leukocytes under high magnification in 10 fields) were performed in all the patients. The definitive diagnosis of an infection was determined according to the Musculoskeletal Infection Society (MSIS). In this group, 30% of the patients were diagnosed with infection using the MSIS criteria (23 of 76 patients).
Results:
With the numbers available, there were no differences between SCRP and frozen section in terms of their ability to diagnose infection. The sensitivity of SCRP was 90% (95% confidence interval [CI], 70.8%-98.6%), the specificity was 94% (95% CI, 84.5%-98.7%), the positive predictive value was 87% (95% CI, 66.3%-97%), and the negative predictive value was 96% (95% CI, 87%-99.4%); the sensitivity, specificity, positive predictive value, and negative predictive value were the same using frozen sections to diagnose infection. The positive likelihood ratio was 16.36 (95% CI, 5.4-49.5), indicating a low probability of an individual without the condition having a positive test, and the negative likelihood ratio was 0.10 (95% CI, 0.03-0.36), indicating low probability of an individual without the condition having a negative test.
Conclusions:
We found that quantitative SCRP had similar diagnostic value as intraoperative frozen section with comparable sensitivity, specificity, and predictive value in a group of patients undergoing revision total hip arthroplasty. In our institution, SCRP is easier to obtain, less expensive, and less dependent on the technique of obtaining and interpreting a frozen section. If our findings are confirmed by other groups, we suggest that quantitative SCRP be considered as a viable alternative to frozen section.
Level Of Evidence:
Level I, diagnostic study.
Insights
Synovial C-reactive protein (SCRP) quantification shows diagnostic accuracy comparable to intraoperative frozen section for periprosthetic joint infection in hip revision surgery. SCRP offers a potentially easier and more cost-effective alternative.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnostics
- Biomarker Analysis
Background:
- Periprosthetic joint infection (PJI) diagnosis relies on sensitive and specific tests.
- Synovial C-reactive protein (SCRP) quantification is a recently developed diagnostic tool for PJI.
- Intraoperative frozen section is a widely accepted diagnostic method for PJI.
Purpose of the Study:
- To compare the diagnostic performance of intraoperative SCRP quantification versus frozen section in revision total hip arthroplasty (THA).
- To evaluate sensitivity, specificity, and predictive values of SCRP in diagnosing PJI during revision THA.
Main Methods:
- Prospective diagnostic study involving 76 patients undergoing revision THA.
- Intraoperative SCRP levels were measured, with 9.5 mg/L set as the infection threshold.
- Frozen section analysis of intraoperative samples was performed.
- Musculoskeletal Infection Society (MSIS) criteria were used for definitive infection diagnosis.
Main Results:
- SCRP quantification demonstrated comparable diagnostic accuracy to frozen section for PJI.
- SCRP sensitivity was 90% and specificity was 94%.
- Frozen section yielded identical sensitivity and specificity values.
- Positive and negative likelihood ratios for SCRP indicated reliable diagnostic capability.
Conclusions:
- Quantitative SCRP offers similar diagnostic value to intraoperative frozen section in revision THA.
- SCRP is potentially easier to obtain, less expensive, and less technique-dependent than frozen section.
- SCRP may be considered a viable alternative to frozen section for PJI diagnosis in revision THA.
