Serum Presepsin Might Not Detect Periprosthetic Joint Infection After Hip Arthroplasty

Background: The purpose of this study was to determine the normative perioperative plasmatic levels of presepsin in patients undergoing primary total hip arthroplasty (THA), and to evaluate whether presepsin measurements can effectively distinguish the presence of periprosthetic joint infection (PJI) following THA. Methods: In study 1, we evaluated multiple inflammatory markers before and at several time points after surgery in 31 primary THA patients. The Kruskal-Wallis test was used to compare sequential changes in each variable followed by the Sheffe post hoc comparison. In study 2, we evaluated the diagnostic accuracy of the inflammatory markers for PJI using five cases with confirmed PJI without bacteremia. ROC curve analysis was performed comparing these PJI cases with the 31 preoperative cases from study 1. Results: In study 1, presepsin levels were not significantly different from the baseline throughout the monitoring period. In study 2, the AUCs of CRP (1.0, p < 0.001) and ESR-1h (0.83, p < 0.05) in the ROC curve were able to discriminate PJI, but those of presepsin (0.51, p = 0.96) and WBC (0.65, p = 0.28) failed to discriminate PJI. Conclusions: Our findings suggest that presepsin levels remain stable following THA and may have limited utility in detecting periprosthetic joint infection, particularly in the absence of systemic infection.