Changes in serum markers failed to predict persistent infection after two-stage exchange arthroplasty

Area of Science:

• Orthopedic surgery
• Infectious disease diagnostics
• Biomarker analysis

Background:

• Two-stage exchange revision for joint infections requires precise reimplantation timing.
• Previous studies conflict on whether normalizing serum markers predict infection control.
• Investigating serum marker changes for persistent infection prediction is crucial.

Purpose of the Study:

• To evaluate if value and percent changes in ESR, CRP, IL-6, and fibrinogen predict persistent periprosthetic joint infection (PJI) after two-stage revision.
• To assess the diagnostic accuracy of these serum marker trends.

Main Methods:

• Retrospective review of 141 patients undergoing two-stage revision (2014-2018).
• Analysis of serum marker value changes (pre-resection minus pre-reimplantation) and percent changes (pre-reimplantation divided by pre-resection).
• Receiver operating characteristic (ROC) curve analysis to determine the predictive value of serum marker changes.

Main Results:

• 15.60% of patients experienced persistent infection.
• No significant differences in serum marker value or percent changes were observed between persistently infected and non-infected patients.
• Area under the curve (AUC) values indicated that both value and percent changes in ESR, CRP, IL-6, and fibrinogen are poor predictors of persistent PJI.

Conclusions:

• Serum marker value and percent changes are not sufficiently reliable for diagnosing persistent infection post-two-stage revision.
• Reimplantation timing decisions should incorporate a range of clinical factors beyond just serum marker trends.