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A Pilot Observational Study Evaluating the Diagnostic Capacity of Rotational Thromboelastometry in Periprosthetic
Andreas G Tsantes1,2, Dimitrios V Papadopoulos3, Stavros Goumenos4
1Laboratory of Haematology and Blood Bank Unit, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Background:
Periprosthetic joint infections (PJIs) are associated with altered hemostatic dynamics; therefore, coagulation laboratory methods such as rotational thromboelastometry (ROTEM) may be valuable in their diagnosis. The aim of this study was to evaluate the diagnostic role of ROTEM in PJI.
Methods:
A diagnostic study was conducted including 65 patients who underwent revision total hip arthroplasty or total knee arthroplasty due to PJI (30 patients) or aseptic loosening (35 patients). Preoperative laboratory evaluation included conventional coagulation studies, inflammatory markers, and ROTEM analysis. These parameters were compared between patients with PJI and patients with aseptic loosening.
Results:
Several ROTEM parameters differed in the patients with PJI, indicating a higher coagulation potential associated with PJI. Specifically, the development of PJI was associated with higher EXTEM maximum clot firmness (MCF) (odds ratio [OR], 1.12 [95% confidence interval (CI), 1.04 to 1.20]; p = 0.001). Among the ROTEM parameters, EXTEM MCF was found to have the highest diagnostic accuracy for PJI (area under the receiver operating characteristic curve, 0.850; sensitivity, 76.6%; specificity, 91.4%), which was comparable with C-reactive protein (CRP) (p = 0.22) and erythrocyte sedimentation rate (ESR) (p = 0.65), but higher than D-dimer (p = 0.037). Moreover, the combined diagnostic accuracy of elevated EXTEM MCF and CRP was improved compared with CRP alone (p = 0.019).
Conclusions:
Our results indicate that ROTEM analysis might be helpful for the detection of the hemostatic derangements that are associated with the development of PJI. However, because of the small size of this pilot study, further research is needed to investigate the value of incorporating viscoelastic studies in diagnostic scores for PJI.
Level Of Evidence:
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Insights
Rotational thromboelastometry (ROTEM) shows potential in diagnosing periprosthetic joint infections (PJIs) by identifying altered hemostasis. EXTEM maximum clot firmness (MCF) demonstrated high accuracy, suggesting ROTEM
Area of Science:
- Orthopedics
- Hematology
- Infectious Diseases
Background:
- Periprosthetic joint infections (PJIs) are linked to changes in blood clotting.
- Coagulation tests like rotational thromboelastometry (ROTEM) may aid PJI diagnosis.
Purpose of the Study:
- To assess the diagnostic utility of ROTEM in identifying PJIs.
- To compare ROTEM parameters with conventional markers in PJI patients.
Main Methods:
- A diagnostic study included 65 patients undergoing revision hip or knee arthroplasty.
- Patients were categorized into PJI (30) or aseptic loosening (35) groups.
- Preoperative evaluations included coagulation studies, inflammatory markers, and ROTEM analysis.
Main Results:
- ROTEM parameters, particularly EXTEM maximum clot firmness (MCF), were significantly higher in PJI patients, indicating increased coagulation.
- EXTEM MCF showed high diagnostic accuracy for PJI (AUC 0.850, sensitivity 76.6%, specificity 91.4%).
- Combined EXTEM MCF and C-reactive protein (CRP) improved diagnostic accuracy compared to CRP alone.
Conclusions:
- ROTEM analysis can help detect hemostatic derangements associated with PJIs.
- Further research is needed to integrate viscoelastic studies into PJI diagnostic scores due to the pilot nature of this study.
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