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Plasma D-Dimer Is Noninferior to Serum C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection

Saad Tarabichi1, Graham S Goh, Colin M Baker

  • 1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.

The Journal of Bone and Joint Surgery. American Volume
|February 9, 2023
PubMed
Abstract

Insights

Plasma D-dimer shows comparable accuracy to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for diagnosing periprosthetic joint infection (PJI). This study suggests D-dimer is a useful screening tool for patients undergoing revision joint arthroplasty.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Periprosthetic joint infection (PJI) diagnosis lacks a single definitive test.
  • Serological markers are crucial screening tools for suspected PJI.
  • The diagnostic utility of plasma D-dimer for PJI requires further investigation.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of plasma D-dimer in identifying PJI.
  • To compare the efficacy of D-dimer with other serological markers (ESR, CRP, fibrinogen) in PJI diagnosis.
  • To assess D-dimer's utility in various clinical scenarios of suspected PJI.

Main Methods:

  • Prospective study of 502 patients undergoing revision hip or knee arthroplasty.
  • PJI diagnosis based on modified 2018 International Consensus Meeting criteria.
  • Preoperative measurement of plasma D-dimer, ESR, CRP, and fibrinogen.
  • Receiver operating characteristic (ROC) curve analysis to determine diagnostic utility.
  • Pairwise comparison with Bonferroni correction for AUC significance.

Main Results:

  • 412 patients included: 317 aseptic, 95 PJI.
  • D-dimer (AUC 0.860), CRP (AUC 0.862), ESR (AUC 0.833), and fibrinogen (AUC 0.798) showed comparable diagnostic accuracy (p > 0.05).
  • D-dimer exhibited the highest sensitivity (93.8%) for infections caused by indolent organisms.

Conclusions:

  • Plasma D-dimer is non-inferior to CRP and ESR in diagnosing PJI.
  • D-dimer serves as a valuable adjunct for screening patients with suspected PJI.
  • These findings support D-dimer's role in the workup of revision total joint arthroplasty patients.

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