Related Experiment Video
Updated: Jul 10, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Diagnosing periprosthetic joint infection
Steven Denyer1, Carlo Eikani1, Monica Sheth1
1Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA.
Aims:
The diagnosis of periprosthetic joint infection (PJI) can be challenging as the symptoms are similar to other conditions, and the markers used for diagnosis have limited sensitivity and specificity. Recent research has suggested using blood cell ratios, such as platelet-to-volume ratio (PVR) and platelet-to-lymphocyte ratio (PLR), to improve diagnostic accuracy. The aim of the study was to further validate the effectiveness of PVR and PLR in diagnosing PJI.
Methods:
A retrospective review was conducted to assess the accuracy of different marker combinations for diagnosing chronic PJI. A total of 573 patients were included in the study, of which 124 knees and 122 hips had a diagnosis of chronic PJI. Complete blood count and synovial fluid analysis were collected. Recently published blood cell ratio cut-off points were applied to receiver operating characteristic curves for all markers and combinations. The area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated.
Results:
The results of the analysis showed that the combination of ESR, CRP, synovial white blood cell count (Syn. WBC), and polymorphonuclear neutrophil percentage (PMN%) with PVR had the highest AUC of 0.99 for knees, with sensitivity of 97.73% and specificity of 100%. Similarly, for hips, this combination had an AUC of 0.98, sensitivity of 96.15%, and specificity of 100.00%.
Conclusion:
This study supports the use of PVR calculated from readily available complete blood counts, combined with established markers, to improve the accuracy in diagnosing chronic PJI in both total hip and knee arthroplasties.
Insights
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.
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.
