Skip to main content

Advertisement

SpringerLink
Log in

Efficacy analysis of clinical serological indicators in the diagnosis of postoperative periprosthetic joint infection in patients with rheumatoid arthritis or osteoarthritis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To investigate the incidence of periprosthetic joint infection (PJI) in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) after primary joint arthroplasty; to analyze the optimal cut-off values of clinical serum markers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer for the diagnosis of PJI in RA patients; and to explore their diagnostic efficacy and clinical significance.

Methods

Clinical data of 15,702 patients with RA (578) or OA (15,124) who underwent total joint arthroplasty from 2013 to 2021 were retrospectively analyzed. Serum CRP, ESR, and D-dimer were recorded for each patient, and subject characteristic curves were used to determine the optimal threshold values of CRP, ESR, and D-dimer for RA-PJI and OA-PJI and to compare the areas under the curves to assess the diagnostic efficacy of the optimal threshold values of serologic indices for RA-PJI.

Results

The five year incidence of PJI was 6.92% in RA patients and 0.67% in OA patients. The optimal thresholds of CRP, ESR, and D-dimer for the diagnosis of RA-PJI were respectively 13.85 mg/L, 33.02 mm/h, and 796.50 ng/mL. The sensitivities of the optimal thresholds were respectively 67.6%, 62.2%, and 56.8%, and the specificities were 74.7%, 60.4%, and 74.4%.

Conclusion

RA patients have a higher incidence of PJI than OA patients. The optimal thresholds for CRP, ESR, and d-dimer for the diagnosis of PJI were higher in RA patients than in OA patients, but the sensitivity and specificity of the diagnosis were not as good as in OA patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dierick F, Avenière T, Cossement M, Poilvache P, Lobet S, Detrembleur C (2004) Outcome assessment in osteoarthritic patients undergoing total knee arthroplasty. Acta Orthop Belg 70:38–45

    PubMed  Google Scholar 

  2. Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86:963–974. https://doi.org/10.2106/00004623-200405000-00012

    Article  PubMed  Google Scholar 

  3. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785. https://doi.org/10.2106/jbjs.f.00222

    Article  PubMed  Google Scholar 

  4. Premkumar A, Kolin DA, Farley KX, Wilson JM, McLawhorn AS, Cross MB, Sculco PK (2021) Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty 36(1484–1489):e1483. https://doi.org/10.1016/j.arth.2020.12.005

    Article  Google Scholar 

  5. Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27:302–345. https://doi.org/10.1128/cmr.00111-13

    Article  PubMed  PubMed Central  Google Scholar 

  6. Voigt J, Mosier M, Darouiche R (2015) Systematic review and meta-analysis of randomized controlled trials of antibiotics and antiseptics for preventing infection in people receiving primary total hip and knee prostheses. Antimicrob Agents Chemother 59:6696–6707. https://doi.org/10.1128/aac.01331-15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tarabichi S, Parvizi J (2023) Prevention of surgical site infection: a ten-step approach. Arthroplasty 5:21. https://doi.org/10.1186/s42836-023-00174-7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bongartz T, Halligan CS, Osmon DR, Reinalda MS, Bamlet WR, Crowson CS, Hanssen AD, Matteson EL (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 59:1713–1720. https://doi.org/10.1002/art.24060

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jämsen E, Huhtala H, Puolakka T, Moilanen T (2009) Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am 91:38–47. https://doi.org/10.2106/jbjs.G.01686

    Article  PubMed  Google Scholar 

  10. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46:2287–2293. https://doi.org/10.1002/art.10524

    Article  PubMed  Google Scholar 

  11. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE (2004) Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 86:1989–1997

    Article  PubMed  Google Scholar 

  12. Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN, Osmon DR (2006) Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 42:471–478. https://doi.org/10.1086/499234

    Article  CAS  PubMed  Google Scholar 

  13. Sanchez-Sotelo J, Berry DJ, Hanssen AD, Cabanela ME (2009) Midterm to long-term followup of staged reimplantation for infected hip arthroplasty. Clin Orthop Relat Res 467:219–224. https://doi.org/10.1007/s11999-008-0480-4

    Article  PubMed  Google Scholar 

  14. Haleem AA, Berry DJ, Hanssen AD (2004) Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res:35–39. https://doi.org/10.1097/01.blo.0000147713.64235.73

  15. Hsieh PH, Huang KC, Shih HN (2013) Prosthetic joint infection in patients with rheumatoid arthritis: an outcome analysis compared with controls. PLoS ONE 8:e71666. https://doi.org/10.1371/journal.pone.0071666

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. JavadParvizi M, Zmistowski Benjamin, Berbari Elie F, Bauer M Thomas W, Springer Bryan D, Della Craig J, Valle Kevin L, Garvin Montri D, Wongworawat Charalampos G, Zalavras Thomas K, Fehring Douglas R, Osmon Michael A, Mont Robert L, Barrack Keith R, Berend John L, Esterhai Terence J, Gioe Steven M, Kurtz Bassam A, Masri Arvind D, Nana Mark J, Spangehl John Segreti (2011) New definition for periprosthetic joint infection. J Arthroplasty 26:1136–1138. https://doi.org/10.1016/j.arth.2011.09.026

    Article  Google Scholar 

  17. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Menard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588. https://doi.org/10.1136/ard.2010.138461

    Article  PubMed  Google Scholar 

  18. Gabriel SE, Michaud K (2009) Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 11. https://doi.org/10.1186/ar2669

  19. Curtis JR, Patkar N, Xie A, Martin C, Allison JJ, Saag M, Shatin D, Saag KG (2007) Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor α antagonists. Arthritis Rheum 56:1125–1133. https://doi.org/10.1002/art.22504

    Article  CAS  PubMed  Google Scholar 

  20. Franklin J, Lunt M, Bunn D, Symmons D, Silman A (2007) Risk and predictors of infection leading to hospitalisation in a large primary-care-derived cohort of patients with inflammatory polyarthritis. Ann Rheum Dis 66:308–312. https://doi.org/10.1136/ard.2006.057265

    Article  PubMed  Google Scholar 

  21. Wolfe F, Caplan L, Michaud K (2006) Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti–tumor necrosis factor therapy. Arthritis Rheum 54:628–634. https://doi.org/10.1002/art.21568

    Article  CAS  PubMed  Google Scholar 

  22. Azboy I, Çatal B, Başarır K, Mutlu M, Bilgen ÖF, Parvizi J (2021) The natural course of serum D-dimer, C-reactive protein, and erythrocyte sedimentation rate levels after uneventful primary total joint arthroplasty. J Arthroplasty 36:3118–3122. https://doi.org/10.1016/j.arth.2021.04.031

    Article  PubMed  Google Scholar 

  23. Lee YS, Lee YK, Han SB, Nam CH, Parvizi J, Koo KH (2018) Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection. J Orthop Surg Res 13:36. https://doi.org/10.1186/s13018-018-0730-4

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hu Q, Fu Y, Tang L (2020) Serum D-dimer as a diagnostic index of PJI and retrospective analysis of etiology in patients with PJI. Clin Chim Acta 506:67–71. https://doi.org/10.1016/j.cca.2020.03.023

    Article  CAS  PubMed  Google Scholar 

  25. Wu H, Pan L, Meng Z, Liu H, Yang X, Cao Y (2022) C-reactive protein (CRP)/albumin-to-globulin ratio (AGR) is a valuable test for diagnosing periprosthetic joint infection: a single-center retrospective study. J Orthop Traumatol 23:36. https://doi.org/10.1186/s10195-022-00657-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. B. A. Marson SRD, D. J. C. Grindlay, B. E. Scammell (2018) Alpha-defensin and the Synovasure lateral flow device for the diagnosis of prosthetic joint infection. https://doi.org/10.1302/0301-620x.100b6.bjj-2017-1563.r1

  27. Baker CM, Goh GS, Tarabichi S, Shohat N, Parvizi J (2022) Synovial C-reactive protein is a useful adjunct for diagnosis of periprosthetic joint infection. J Arthroplasty 37(2437–2443):e2431. https://doi.org/10.1016/j.arth.2022.06.016

    Article  Google Scholar 

  28. Hantouly AT, Salameh M, Toubasi AA, Salman LA, Alzobi O, Ahmed AF, Hameed S, Zikria B, Ahmed G (2022) Synovial fluid calprotectin in diagnosing periprosthetic joint infection: a meta-analysis. Int Orthop 46:971–981. https://doi.org/10.1007/s00264-022-05357-6

    Article  PubMed  Google Scholar 

  29. Miyamae Y, George J, Klika AK, Barsoum WK, Higuera CA (2019) Diagnostic accuracy of the alpha-defensin test for periprosthetic joint infection in patients with inflammatory diseases. J Arthroplasty 34:1767–1771. https://doi.org/10.1016/j.arth.2019.04.020

    Article  PubMed  Google Scholar 

  30. Klim SM, Amerstorfer F, Gruber G, Bernhardt GA, Radl R, Leitner L, Leithner A, Glehr M (2018) Fibrinogen - a practical and cost efficient biomarker for detecting periprosthetic joint infection. Sci Rep 8:8802. https://doi.org/10.1038/s41598-018-27198-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Yang F, Zhao C, Huang R, Ma H, Wang X, Wang G, Zhao X (2021) Plasma fibrinogen in the diagnosis of periprosthetic joint infection. Sci Rep 11:677. https://doi.org/10.1038/s41598-020-80547-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Yu B-Z, Fu J, Chai W, Hao L-B, Chen J-Y (2020) Neutrophil to lymphocyte ratio as a predictor for diagnosis of early periprosthetic joint infection. BMC Musculoskeletal Disord 21. https://doi.org/10.1186/s12891-020-03704-5

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266071, China

    Hengxin Zhao, Lianggang Li, Hong-Yu Wang, Lanfeng Ding, Yuanhe Wang, Xiaokai Liu & Shaoqi Tian

  2. Department of Gynecology, The Women and Children’s Hospital of Qingdao, Tongfu Road 6, Qingdao, 266034, China

    Yan Wang

Authors
  1. Hengxin Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lianggang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Yu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lanfeng Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuanhe Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaokai Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shaoqi Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Study proposal and design were done by Tian Shaoqi. Material preparation, data collection, and analysis were performed by Zhao Hengxin, Li Lianggang, and Wang Hongyu. The first draft of the manuscript was written by Zhao Hengxin and Ding Lanfeng. Manuscript revisions were done by Wang Yuanhe and Liu Xiaokai. Wang Yan was responsible for correcting the grammar of the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Shaoqi Tian or Yan Wang.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of The Affiliated Hospital of Qingdao University (Date September 16, 2023/No. QYFY WZLL 28084).

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, H., Li, L., Wang, HY. et al. Efficacy analysis of clinical serological indicators in the diagnosis of postoperative periprosthetic joint infection in patients with rheumatoid arthritis or osteoarthritis. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06171-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00264-024-06171-y

Keywords

Search

Navigation