Combining C-reactive Protein and Interleukin-6 May Be Useful to Detect Periprosthetic Hip Infection

Abstract

Background The sensitivity and specificity to detect periprosthetic infection of the different methods have been questioned, and no single laboratory test accurately detects infection before revision arthroplasty. Questions/purposes We asked whether preoperative C-reactive protein (CRP) and interleukin-6 (IL-6) could lead to similar sensitivity, specificity, and predictive values as our previous results obtained with intraoperative frozen section (FS) in revision total hip arthroplasty (THA). Methods We prospectively followed 69 patients who had undergone revision THA for failure of a primary THA. The definitive diagnosis of an infection was determined on the basis of positive histopathologic evidence of infection or growth of bacteria on culture.

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

“…The predictive power of the CRP value in our study was less than that reported by other authors [9,46,51]. At a cutoff point of 10 mg/L Schinsky et al [46], Tohtz et al [51], and Buttaro et al [9] regarded the CRP level as an important diagnostic parameter and found a sensitivity between 58% and 94%, specificity between 80% and 91%, PPV between 55% and 61%, NPV between 82% and 96%, and accuracy between 73% and 78%.…”

“…At a cutoff point of 10 mg/L Schinsky et al [46], Tohtz et al [51], and Buttaro et al [9] regarded the CRP level as an important diagnostic parameter and found a sensitivity between 58% and 94%, specificity between 80% and 91%, PPV between 55% and 61%, NPV between 82% and 96%, and accuracy between 73% and 78%. Moreover, the AAOS Work Group pointed out in their guidelines that aspiration or biopsy should be done only if the CRP is increased [1].…”

“…The hip was considered histologically positive when at least five polymorphonuclear leukocytes per high power field (9400) were identified in one of 10 such fields [37,38,42]. A CRP value greater than 10 mg/L was regarded as positive [9,46,51].…”

Intraoperative Synovial C-reactive Protein Is as Useful as Frozen Section to Detect Periprosthetic Hip Infection

“…We have previously studied the combination of serum CRP and interleukin-6 to detect PJI and compared with frozen section. Serum CRP and interleukin-6 provided similar sensitivity, specificity, and positive predictive values as the frozen section [5]. However, limitations of the interleukin-6 diagnostic method include high cost and relative lack of availability: in our institution, for logistic reasons, all IL-6 samples were saved and performed intermittently in batches.…”

Cytokines and Microbiocenosis in Predicting the Postoperative Period Course in Patients with Periprosthetic Infection of the Hip Joint After Removal of the Infected Implant

“…Согласно результатам наших исследований, со стороны цитокинов наблюдалась различ-ная динамика в зависимости от особенностей течения послеоперационного периода. Наи-более активным показал себя IL-6, цитокин, являющийся общепризнанным маркером гнойно-воспалительного процесса, включая перипротезную инфекцию [8,9,10].…”