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Finding the Optimal Screening Test for Periprosthetic Joint Infection: A Prospective Study
Saad Tarabichi1, Juan D Lizcano1, Elizabeth A Abe1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
The Journal of Arthroplasty
|March 7, 2024
Summary
Plasma D-dimer shows superior specificity as a screening tool for periprosthetic joint infection (PJI) compared to CRP, ESR, and fibrinogen. This finding aids in optimizing PJI diagnosis and patient management.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Diagnostic Medicine
Background:
- Periprosthetic joint infection (PJI) diagnosis lacks a single definitive test.
- Serological markers are utilized to screen for PJI and reduce unnecessary joint aspirations.
Purpose of the Study:
- To evaluate the effectiveness of standard serological tests as a screening tool for PJI in patients undergoing revision arthroplasty.
Main Methods:
- Prospective study of 412 patients undergoing revision hip or knee arthroplasty.
- Measured plasma D-dimer, ESR, CRP, and fibrinogen preoperatively.
- Assessed diagnostic utility using ROC curves and compared AUCs.
Main Results:
- D-dimer (AUC 0.860), CRP (AUC 0.862), ESR (AUC 0.833), and fibrinogen (AUC 0.798) showed comparable diagnostic accuracy.
- At 100% sensitivity, D-dimer achieved the highest specificity (40.2%).
- An optimal cutoff of ≥ 244 ng/mL for plasma D-dimer was identified.
Conclusions:
- Plasma D-dimer demonstrates comparable diagnostic accuracy to CRP, ESR, and fibrinogen for PJI.
- D-dimer is a superior screening test for PJI, particularly when maximizing sensitivity.
