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Synovial D-dimer is a novel and accurate test for diagnosis of chronic knee periprosthetic joint infection
Zirvecan Güneş1, Mehmet Kürşat Yılmaz2, Bahattin Kemah3
1Orthopaedics and Traumatology, Görele State Hospital, Giresun, Turkey.
Background:
Despite numerous tests and guidelines, diagnosing periprosthetic joint infection (PJI) remains challenging. The study aimed to determine the value of synovial D-dimer, rather than serum, in diagnosing PJI.
Methods:
This prospective study enrolled 17 patients with chronic knee PJI (the PJI group) and 52 with primary knee osteoarthritis (the control group). PJI was defined using the 2018 International Consensus Meeting Criteria. Synovial D-dimer, plasma D-dimer, serum erythrocyte sedimentation rate, and serum C-reactive protein levels were measured. Synovial fluid D-dimer levels were determined using an enzyme-linked fluorescence assay. The performance of each biomarker in diagnosing PJI was evaluated using receiver operating characteristic (ROC) curves.
Results:
The median synovial D-dimer level was significantly higher in the PJI group at (927,095 ng/ml, IQR 566,882-1,215,066) than in the control group (20,954 ng/ml, IQR 10,350-46,493) (P < 0.001). When the synovial D-dimer threshold value was determined to be 236,804 ng/ml, the sensitivity was 100% (CI 93.2-100%), and the specificity was 94.12% (95% CI 71.3-99.9). The area under the curve determined by ROC analysis was 0.992 (95% CI 0.992-1.000, P < 0.0001).
Conclusions:
Patients with chronic knee PJI have significantly high synovial D-dimer levels, demonstrating that an increase in fibrinolytic activity coexists with an infection-induced inflammatory response. Synovial D-dimer levels appear to be valuable biomarkers for diagnosing PJI. However, further studies are required to evaluate the role of this novel biomarker.
Insights
Synovial D-dimer is a highly sensitive and specific biomarker for diagnosing periprosthetic joint infection (PJI). This study highlights its potential to improve PJI diagnosis over traditional methods.
Area of Science:
- Biomarkers
- Orthopedic Surgery
- Infectious Diseases
Background:
- Diagnosing periprosthetic joint infection (PJI) remains a significant clinical challenge despite existing guidelines and diagnostic tools.
- The study addresses the need for more accurate diagnostic markers for PJI, focusing on synovial fluid analysis.
Purpose of the Study:
- To evaluate the diagnostic value of synovial D-dimer for periprosthetic joint infection (PJI).
- To compare the efficacy of synovial D-dimer against other biomarkers like plasma D-dimer, erythrocyte sedimentation rate, and C-reactive protein in PJI diagnosis.
Main Methods:
- A prospective study involving 17 patients with chronic knee PJI and 52 controls with primary knee osteoarthritis.
- Measurement of synovial D-dimer, plasma D-dimer, serum erythrocyte sedimentation rate, and serum C-reactive protein.
- Receiver operating characteristic (ROC) curve analysis was employed to assess the diagnostic performance of each biomarker.
Main Results:
- Synovial D-dimer levels were significantly elevated in the PJI group compared to the control group (P < 0.001).
- A synovial D-dimer threshold of 236,804 ng/ml demonstrated 100% sensitivity and 94.12% specificity for PJI diagnosis.
- ROC analysis yielded an area under the curve of 0.992, indicating excellent diagnostic performance.
Conclusions:
- Elevated synovial D-dimer levels in chronic knee PJI suggest increased fibrinolytic activity linked to the inflammatory response.
- Synovial D-dimer shows significant promise as a valuable biomarker for diagnosing PJI.
- Further research is warranted to fully establish the clinical utility of synovial D-dimer in PJI diagnostics.
