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Diagnosing periprosthetic joint infection.

Steven Denyer¹, Carlo Eikani¹, Monica Sheth¹

¹Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA.

Bone & Joint Open

|November 20, 2023

Summary

Platelet-to-volume ratio (PVR), combined with standard markers, significantly enhances the diagnosis of chronic periprosthetic joint infection (PJI) in hip and knee replacements. This combination offers high accuracy and reliability for PJI detection.

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Area of Science:

Orthopedics
Infectious Diseases
Hematology

Background:

Periprosthetic joint infection (PJI) diagnosis is challenging due to overlapping symptoms and limited accuracy of current markers.
Blood cell ratios, like platelet-to-volume ratio (PVR), are emerging as potential tools to improve diagnostic accuracy.
Existing diagnostic markers for PJI often lack sufficient sensitivity and specificity.

Purpose of the Study:

To validate the effectiveness of PVR and platelet-to-lymphocyte ratio (PLR) in diagnosing chronic PJI.
To assess the diagnostic accuracy of various marker combinations, including blood cell ratios.
To determine the utility of PVR in improving PJI diagnosis for hip and knee arthroplasties.

Main Methods:

Retrospective review of 573 patients undergoing total hip or knee arthroplasty.
Analysis of complete blood counts and synovial fluid markers.
Application of receiver operating characteristic curves to evaluate marker combinations and calculate AUC, sensitivity, and specificity.

Main Results:

A combination of ESR, CRP, synovial white blood cell count, PMN%, and PVR achieved an AUC of 0.99 for knee PJI, with 97.73% sensitivity and 100% specificity.
For hip PJI, the same combination yielded an AUC of 0.98, with 96.15% sensitivity and 100% specificity.
PVR demonstrated significant value when integrated with established diagnostic markers.

Conclusions:

The study supports the integration of PVR into diagnostic protocols for chronic PJI.
PVR, derived from complete blood counts, offers a readily accessible method to enhance diagnostic accuracy.
This approach improves the diagnosis of chronic PJI in both total hip and knee arthroplasties.