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Analysis of Serum and Synovial Inflammatory Markers in Periprosthetic Joint Infections: A Narrative Review
Amit K Yadav1, Siddhartha Murhekar2, Ece N Cinar3
1Orthopaedics and Traumatology, Wrightington Hospital, Wigan, GBR.
Abstract:
Periprosthetic joint infection (PJI) is considered a rare but devastating complication after total joint arthroplasty (TJA). The problem lies in the fact that there is a paucity of "gold standard" diagnostic tests that make the diagnosis of PJI extremely challenging. Recently, there have been increasing evidence-based guidelines that have been introduced to standardise the approach to a patient with a suspected PJI. Diagnosing a case of PJI traditionally involves initial screening for elevated serum inflammation markers C-reactive protein (CRP) (mg/dL) and erythrocyte sedimentation rate (ESR), and aspiration remains the sole confirmatory investigation. However, several factors would affect the values of the aforementioned markers, such as gender, age, and the presence of inflammatory circumstances. Serum D-dimer that detects fibrinolytic activities during infection has high sensitivity, but the specificity was not persuasive as it would elevate during other conditions, such as venous thromboembolism. Therefore, there is also a need for a simultaneous and secondary marker. There are also several synovial biomarkers, including ESR, CRP, alpha-defensin, and synovial fluid leukocyte count and differential for the detection of PJI. In this narrative review, we want to sum up the serum and inflammatory markers that have been introduced so far for detecting PJI.
Insights
Diagnosing periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) is challenging due to a lack of definitive tests. This review summarizes serum and inflammatory markers for improved PJI detection.
Area of Science:
- Orthopedics
- Infectious Diseases
- Medical Diagnostics
Background:
- Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty (TJA).
- Accurate diagnosis of PJI is difficult due to the absence of a definitive "gold standard" test.
- Existing diagnostic markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be influenced by various factors.
Purpose of the Study:
- To review and summarize serum and inflammatory biomarkers for diagnosing PJI.
- To highlight the need for improved diagnostic accuracy in suspected PJI cases.
- To discuss the limitations of current diagnostic markers and the potential of new markers.
Main Methods:
- Narrative review of existing literature on PJI diagnostic markers.
- Analysis of serum inflammatory markers (CRP, ESR, D-dimer) and synovial fluid biomarkers.
- Evaluation of marker sensitivity and specificity in PJI detection.
Main Results:
- Traditional markers (CRP, ESR) have limitations affecting their diagnostic value in PJI.
- Serum D-dimer shows high sensitivity but lacks specificity for PJI diagnosis.
- Synovial biomarkers like alpha-defensin and leukocyte counts are also considered for PJI detection.
Conclusions:
- Accurate PJI diagnosis requires a multi-faceted approach, potentially combining multiple biomarkers.
- Further research is needed to establish reliable secondary markers for PJI.
- Standardized diagnostic guidelines are crucial for managing suspected PJI cases effectively.
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