The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

Abstract

Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

Utility of Diagnostic Tests Before Reimplantation in Patients Undergoing 2-Stage Revision Total Joint Arthroplasty

“…After title and abstract screening, 1,292 articles were removed, leaving 80 articles for full-text screening. During full-text screening, 32 articles were excluded primarily because of the lack of diagnostic accuracy measures being reported (n = 10), including multiple PJI treatment strategies (i.e., 1-stage revision and/or debridement, antibiotics, and implant retention; n = 5); the article type not meeting inclusion (n = 4); and evaluating biomarkers or tools not included in this study such as synovial cytokines, CRP/albumin ratio, and indium-111 leukocyte scans (n = 4), along with other reasons (n = 9), leaving 47 articles 20-40 for inclusion in this study 41-66 (Fig. 1).…”

“…There were 14 serum/plasma/synovial biomarkers and cultures reported among the included studies. Fourteen studies reported serum CRP 24,31,33,34,36-38,40-42,49,56,58,66 ; 12 reported tissue culture 21,23,29,35,46,47,51,54,60-63 ; 9 reported serum ESR 31,33,34,40-42,49,58,66 ; 9 reported synovial WBC count 22,25,26,36,38,40,48,58,66 ; 9 reported synovial culture 23,25,26,38,43-45,48,50 ; 8 reported tissue frozen section 27,30-32,35,52,54,65 ; 6 reported synovial PMN % 22,36,40,48,58,66 ; 4 reported plasma D-dimer 20,41,49,64 ; 4 reported synovial AD 24,28,55,59 ; 3 reported spacer sonication culture 23,47,60 ; 2 reported serum IL-6 37,53 ; 2 reported serum fibrinogen 24,64 ; 2 reported synovial LE test strips from DFI and Roche Diagnostics, respectively 24,39 ; and 1 reported serum D-dimer 57 . In total, 6,605 diagnostic tests among 3,781 cases of PJI were included in this study, with 723 cases (19.1%) experiencing persistent infection or treatment failure (Table IV).…”