Circulating Cytokines after Hip and Knee Arthroplasty: A Preliminary Study

Shah, Kalpesh; Aslam, M.; Patil, Sanjeev; McFadyen, Angus; Meek, R.M. Dominic

doi:10.1007/s11999-008-0562-3

Cited by 47 publications

(32 citation statements)

References 36 publications

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“…We found elevated serum CRP levels in the infected group, while the ESR values were not. This may correspond to the observation that CRP levels tend to normalize at a faster rate after an inflammatory-generating insult than ESR [24].…”

Section: Discussionsupporting

confidence: 70%

The Mark Coventry Award: Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid Analysis

Bedair

Ting

Jacovides

et al. 2011

Clinical Orthopaedics &Amp; Related Research

235

128

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Background Synovial fluid white blood cell count is useful for diagnosing periprosthetic infections but the utility of this test in the early postoperative period remains unknown as hemarthrosis and postoperative inflammation may render standard cutoff values inaccurate. Questions/purposes We evaluated the diagnostic performance of four common laboratory tests, the synovial white blood cell count, differential, C-reactive protein, and erythrocyte sedimentation rate to detect infection in the first 6 weeks after primary TKA. Methods We reviewed 11,964 primary TKAs and identified 146 that had a knee aspiration within 6 weeks of surgery. Infection was diagnosed in 19 of the 146 knees by positive cultures or gross purulence. We compared demographic information, time from surgery, and the laboratory test values between infected and noninfected knees to determine if any could identify infection early postoperatively. Receiver operating characteristic curves were constructed to determine optimal cutoff values for each of the test parameters. Results Synovial white blood cell count (92,600 versus 4200 cells/lL), percentage of polymorphonuclear cells (89.6% versus 76.9%), and C-reactive protein (171 versus 88 mg/L) were higher in the infected group. The optimal synovial white blood cell cutoff was 27,800 cells/lL (sensitivity, 84%; specificity, 99%; positive predictive value, 94%; negative predictive value, 98%) for diagnosing infection. The optimal cutoff for the differential was 89% polymorphonuclear cells and for C-reactive protein 95 mg/L. Conclusions With a cutoff of 27,800 cells/lL, synovial white blood cell count predicted infection within 6 weeks after primary TKA with a positive predicted value of 94% and a negative predictive value of 98%. The use of standard cutoff values for this parameter (* 3000 cells/lL) would have led to unnecessary reoperations.

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Section: Discussionsupporting

confidence: 70%

The Mark Coventry Award: Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid Analysis

Bedair

Ting

Jacovides

et al. 2011

Clinical Orthopaedics &Amp; Related Research

235

128

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“…techniques [8,25,30,31,35]) as well as developing novel methods for diagnosing infection (polymerase chain reaction techniques [1,6,18,24,26], sonication of implants [50], and analysis of circulating cytokines [7,9,13,47]). The more we learn about the histopathologic characteristics of infected versus uninfected joints, the better able we will be to identify clinically relevant characteristics of infections [28,37,[39][40][41].…”

Section: Clinical Orthopaedics and Related Research ® A Publication Omentioning

confidence: 99%

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Parvızı

Jacovides

Adeli

et al. 2012

Clinical Orthopaedics &Amp; Related Research

101

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Background C-reactive protein (CRP) serum assays are a standard element of the diagnostic workup for periprosthetic joint infection (PJI). However, because CRP is a marker for systemic inflammation, this test is not specific to PJI. Questions/purposes Our purpose was to assess whether synovial fluid and serum assays alone could differentiate between infected and uninfected revision knee arthroplasties and to determine which of these methods had the greatest diagnostic accuracy. Methods We collected synovial fluid specimens from 66 patients undergoing revision total knee arthroplasty. Patients were judged uninfected or infected by standardized criteria. Synovial CRP levels were measured using an individual CRP assay (15 samples; 10 infected, five uninfected) and a multiplex immunoassay platform (59 samples; 25 infected, 34 uninfected). Results from preoperative standard serum CRP assays conducted were also collected (55 samples; 25 infected, 30 uninfected). Sensitivity, specificity, and receiver operating characteristic curve analyses were performed for each assay with a diagnosis of infection based on previously established criteria.Results Synovial CRP concentrations differed between infected and uninfected joints in the multiplex and serum analyses. The area under the curve was 0.84 for the individual assay, 0.91 for the multiplex assay, and 0.88 for the serum CRP assay. Sensitivity and specificity were 70.0% and 100.0% for the individual enzyme-linked immunosorbent assay, 84.0% and 97.1% for the multiplex assay, and 76.0% and 93.3% for the serum CRP assay. Conclusions An assay measuring CRP in synovial fluid may be more accurate in diagnosing PJI than the standard serum CRP assay. We believe such an assay holds promise as a new diagnostic marker for PJI.

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“…Although evidence-based recommendations for standardizing the diagnosis exist [9,23,27], there is no gold standard for diagnosis [2,24,36]. Efforts are ongoing to elucidate novel methods for detecting PJI, such as sonication of implants [32], molecular techniques [1,4,19,20], and analysis of circulating cytokines [5,12,29]. However, many of these new diagnostic measures are costly, require special equipment, or are time-consuming and thus not readily available [2,24,36].…”

Section: Introductionmentioning

confidence: 99%

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Tetreault

Wetters

Moric

et al. 2014

Clin Orthop Relat Res

102

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Background Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing periprosthetic joint infection (PJI). Questions/purposes We aimed to (1) determine if there is a correlation between serum and synovial CRP values, (2) establish cutoff values for diagnosing infection based on serum and synovial CRP, and (3) compare the utility of measuring CRP in synovial fluid versus serum for the diagnosis of PJI using standard assay equipment available at most hospitals. Methods Between February 2011 and March 2012, we invited all 150 patients scheduled for revision TKA (84) or THA (66) to participate in this prospective study, of whom 100% agreed. Data ultimately were missing for 31 patients, leaving 60 patients undergoing revision TKA and 59 undergoing revision THA (71% and 89% of the original group, respectively) for whom CRP level was measured in serum and synovial fluid samples. Patients were deemed to have a PJI (32) or no infection (87) using Musculoskeletal Infection Society criteria. Serum and synovial CRP levels were assayed using the same immunospectrophotometer and the correlation coefficient was calculated. Receiver operating characteristic curve analyses were performed to compare utility in diagnosing PJI, which included area under the curve, diagnostic threshold, and test sensitivity, specificity, predictive values, and accuracy. In 22 of 150 patients (14.7%), synovial CRP could not be measured because the sample was too viscous or hemolyzed. Results In the analyzed 119 samples, there was a strong correlation (r = 0.76; p \ 0.001) between synovial and serum CRP. The area under the curve was 0.90 both for the synovial fluid (95% CI, 0.82-0.97) and serum (95% CI, 0.84-0.96) CRP assays. The diagnostic thresholds were 6.6 mg/L for synovial fluid and 11.2 mg/L for serum. Sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were similar for synovial fluid and serum assays. Conclusions Although recent studies have suggested a superiority of synovial fluid CRP over serum CRP for the diagnosis of PJI, we found that measurement of CRP in synovial fluid rather than serum using readily available

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Circulating Cytokines after Hip and Knee Arthroplasty: A Preliminary Study

Abstract: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 47 publications

References 36 publications

The Mark Coventry Award: Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid Analysis

The Mark Coventry Award: Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid Analysis

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

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