Related Experiment Video
Updated: Jul 16, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
D-dimer in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis
Guangxu Lu1,2,3, Tong Li2, Haoqi Ye1
1Department of Logistics University of PAP, Tianjin, 300309, China.
Background:
D-dimer, a coagulation-related indicator, has recently been used as a tool for the diagnosis of periprosthetic joint infection (PJI), but its reliability is uncertain. The purpose of this systematic review and meta-analysis was to explore the accuracy of D-dimer in the diagnosis of PJI after joint arthroplasty.
Methods:
We systematically searched the MEDLINE, EMBASE, and Cochrane databases for relevant literature about D-dimer in the diagnosis of PJI. QUADAS-2 was used to assess the risk of bias and clinical applicability of each included study. We used the bivariate meta-analysis framework to pool the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the SROC curve (AUC). Univariate meta-regression and subgroup analyses were performed to explore the sources of heterogeneity.
Results:
We included 8 eligible studies. The pooled diagnostic sensitivity and specificity were 0.82 (95% CI, 0.70-0.89) and 0.70 (95% CI, 0.55-0.82), respectively. The pooled PLR, NLR, and DOR were 2.7 (95% CI, 1.7-4.4), 0.26 (95% CI, 0.15-0.46), and 10 (95% CI, 4-25), respectively. The AUC was 0.83 (95% CI, 0.8-0.86). Serum D-dimer might have higher diagnostic accuracy than plasma D-dimer for PJI (pooled sensitivity: 0.88 vs 0.67; pooled specificity: 0.76 vs 0.61).
Conclusions:
D-dimer has limited performance for the diagnosis of PJI.
Insights
D-dimer shows limited diagnostic accuracy for periprosthetic joint infection (PJI). This systematic review found its performance insufficient for reliable PJI diagnosis after joint arthroplasty.
Area of Science:
- Orthopedic Surgery
- Diagnostic Accuracy
- Biomarker Research
Background:
- Periprosthetic joint infection (PJI) diagnosis is challenging.
- D-dimer, a marker of coagulation, is being explored for PJI detection.
- Its diagnostic reliability for PJI remains uncertain.
Purpose of the Study:
- To systematically review and meta-analyze the accuracy of D-dimer in diagnosing PJI.
- To assess the diagnostic performance of D-dimer in patients undergoing joint arthroplasty.
Main Methods:
- Systematic search of MEDLINE, EMBASE, and Cochrane databases.
- Quality assessment using QUADAS-2.
- Bivariate meta-analysis to pool sensitivity, specificity, PLR, NLR, DOR, and AUC.
- Meta-regression and subgroup analyses to explore heterogeneity.
Main Results:
- Included 8 studies.
- Pooled sensitivity: 0.82 (95% CI, 0.70-0.89).
- Pooled specificity: 0.70 (95% CI, 0.55-0.82).
- Area under the SROC curve (AUC): 0.83 (95% CI, 0.8-0.86).
- Serum D-dimer showed potentially higher accuracy than plasma D-dimer.
Conclusions:
- D-dimer demonstrates limited performance in diagnosing PJI.
- Current evidence suggests insufficient reliability for routine PJI diagnosis.
