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Lipopolysaccharide-binding protein: A valuable biomarker in the differentiation between periprosthetic joint infection and aseptic loosening?

International Orthopaedics volume 38, pages 2201–2207 (2014)Cite this article

Abstract

Purpose

The pre-operative differentiation between periprosthetic joint infection (PJI) and aseptic loosening after total hip (THA) or knee (TKA) arthroplasty is essential for successful therapy and relies in part on the use of molecular markers. The objective of this study was to assess serum levels of lipopolysaccharide-binding protein (LBP) as a diagnostic tool for PJI and to compare its accuracy with standard tests.

Methods

One hundred and twenty patients presenting with a painful TKA or TKA with indication for surgical revision were included in this prospective, controlled, clinical trial at a single centre. Pre-operative blood and serum samples were collected and analysed for white blood cell (WBC) count, C-reactive protein (CRP) and LBP. The definite diagnosis of periprosthetic joint infection was determined on the basis of clinical, microbiological and histopathological examination.

Results

LBP showed significantly higher values in PJI compared with aseptic loosening (p < 0.001) and control (p < 0.001), with a specificity of 66 % and a sensitivity of 71 % at a cutoff value of >7 ng/ml. In combination with CRP, the positive predictive value for PJI was at 0.67; negative predictive value with both negative was at 0.77.

Discussion

Patients with PJI have elevated serum levels of LBP when compared with patients with aseptic loosening. The use of LBP in serum appears not to be a more accurate marker than CRP level in serum for detecting PJI. On the basis of these results, we cannot recommend the sole use of LBP for differentiating PJI and aseptic loosening following THA and TKA.

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Acknowledgments

This study was funded by a grant from the “Deutsch Arthrose-Hilfe e.V.” (http://www.arthrose.de/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author information

Affiliations

  1. Department of Orthopedics and Trauma Surgery, University Clinic of Bonn, Sigmund Freud Str. 25, 53105, Bonn, Germany

    Max J. Friedrich, Thomas M. Randau, Matthias D. Wimmer, Ben Reichert, Dominik Kuberra, Dieter C. Wirtz & Sascha Gravius

  2. Institute for Clinical Chemistry and Clinical Pharmacology, University Clinic of Bonn, Bonn, Germany

    Birgit Stoffel-Wagner

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  1. Max J. Friedrich
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  2. Thomas M. Randau
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  3. Matthias D. Wimmer
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Correspondence to Max J. Friedrich.

Additional information

Max J. Friedrich and Thomas M. Randau contributed equally.

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Friedrich, M.J., Randau, T.M., Wimmer, M.D. et al. Lipopolysaccharide-binding protein: A valuable biomarker in the differentiation between periprosthetic joint infection and aseptic loosening?. International Orthopaedics (SICOT) 38, 2201–2207 (2014). https://doi.org/10.1007/s00264-014-2351-9

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  • DOI: https://doi.org/10.1007/s00264-014-2351-9

Keywords

  • Infection
  • Arthroplasty
  • Biomarkers
  • Lipopolysaccharide-binding protein
  • Periprosthetic joint infection
  • Diagnostics
  • Aseptic loosening