Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study

Praz, César; Gubbiotti, Laura; Buia, Geoffrey; Chapus, Valentin; Dunet, Julien; Grandhomme, Frédérique; Michon, J.; Rochcongar, Goulven; Hulet, Christophe

doi:10.1016/j.otsr.2021.102903

Cited by 14 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Comparable results were found by Praz et al This group analyzed serum CRP kinetics and found significantly higher serum CRP values in septic revision after primary hip and knee arthroplasties. The authors describe a sensitivity and specificity of 87.5% and 86.1%, respectively, in detecting a PJI with serum CRP values (cut-off 9 mg/L) [40]. When we used just a single value (maximum CRP), we were able to achieve a comparable sensitivity of 75%, but lower specificity of 57%.…”

Section: Discussionmentioning

confidence: 92%

Predicting the Exception—CRP and Primary Hip Arthroplasty

Meier

Bauer

Maheshwari

et al. 2021

JCM

View full text Add to dashboard Cite

Background: While primary hip arthroplasty is the most common operative procedure in orthopedic surgery, a periprosthetic joint infection is its most severe complication. Early detection and prediction are crucial. In this study, we aimed to determine the value of postoperative C-reactive protein (CRP) and develop a formula to predict this rare, but devastating complication. Methods: We retrospectively evaluated 708 patients with primary hip arthroplasty. CRP, white blood cell count (WBC), and several patient characteristics were assessed for 20 days following the operative procedure. Results: Eight patients suffered an early acute periprosthetic infection. The maximum CRP predicted an infection with a sensitivity and specificity of 75% and 56.9%, respectively, while a binary logistic regression reached values of 75% and 80%. A multinominal logistic regression, however, was able to predict an early infection with a sensitivity and specificity of 87.5% and 78.9%. With a one-phase decay, 71.6% of the postoperative CRP-variance could be predicted. Conclusion: To predict early acute periprosthetic joint infection after primary hip arthroplasty, a multinominal logistic regression is the most promising approach. Including five parameters, an early infection can be predicted on day 5 after the operative procedure with 87.5% sensitivity, while it can be excluded with 78.9% specificity.

show abstract

Section: Discussionmentioning

confidence: 92%

Predicting the Exception—CRP and Primary Hip Arthroplasty

Meier

Bauer

Maheshwari

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…1, and the QUADAS‐2 score criteria revealed that most of the extracted studies had high risks. Excluding brand new markers that only appeared recently and have limited data, 129 records reported diagnostic information of serum markers (serum CRP, ESR, procalcitonin, IL‐6, D‐Dimer, WBC, platelet count [PLT], neutrophil to lymphocyte ratio [NLR], monocyte to lymphocyte ratio [MLR], platelet to lymphocyte ratio [PLR], platelet to mean platelet volume ratio [PVR], FDP [fibrin degradation product] and Fibrinogen), 9–11,24–149 114 studies reported synovial markers (synovial WBC, PMN%, IL‐6, IL‐1β, CRP, TNF‐α, Calprotectin, and leucocyte esterase [LE] and laboratory or lateral‐flow based α‐defensin test),…”

Section: Resultsmentioning

confidence: 99%

“…Final analysis was performed on 215 articles with six additional studies searched manually, as shown in platelet to mean platelet volume ratio [PVR], FDP [fibrin degradation product] and Fibrinogen), [9][10][11] 114 studies reported synovial markers (synovial WBC, PMN%, IL-6, IL-1β, CRP, TNF-α, Calprotectin, and leucocyte esterase [LE] and laboratory or lateral-flow based α-defensin test), 10,29,31,34,36,43,49,51,52,58,59,61,62,64,65,[72][73][74]76,77,[79][80][81][84][85][86][87][88]90,95,97,99,117,118,122,124,125,127,129,132,[135][136][137][138]142,1...…”

Section: Study Selectionmentioning

confidence: 99%

Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review

Tang

Yuan

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective The current diagnostic criteria for periprosthetic joint infection (PJI) are diverse and controversial, leading to delayed diagnosis. This study aimed to evaluate and unify their diagnostic accuracy and the threshold selection of serum and synovial routine tests for PJI at an early stage. Methods We searched the MEDLINE and Embase databases for retrospective or prospective studies which reported preoperative‐available assays (serum, synovial, or culture tests) for the diagnosis of chronic PJI among inflammatory arthritis (IA) or non‐IA populations from January 1, 2000 to June 30, 2022. Threshold effective analysis was performed on synovial polymorphonuclear neutrophils (PMN%), synovial white blood cell (WBC), serum C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to find the relevant cut‐offs. Results Two hundred and sixteen studies and information from 45,316 individuals were included in the final analysis. Synovial laboratory‐based α‐defensin and calprotectin had the best comprehensive sensitivity (0.91 [0.86–0.94], 0.95 [0.88–0.98]) and specificity (0.96 [0.94‐0.97], 0.95 [0.89–0.98]) values. According to the threshold effect analysis, the recommended cut‐offs are 70% (sensitivity 0.89 [0.85–0.92], specificity 0.90 [0.87–0.93]), 4100/μL (sensitivity 0.90 [0.87–0.93], specificity 0.97 [0.93–0.98]), 13.5 mg/L (sensitivity 0.84 [0.78–0.89], specificity 0.83 [0.73–0.89]), and 30 mm/h (sensitivity 0.79 [0.74–0.83], specificity 0.78 [0.72–0.83]) for synovial PMN%, synovial WBC, serum CRP, and ESR, respectively, and tests seem to be more reliable among non‐IA patients. Conclusions The laboratory‐based synovial α‐defensin and synovial calprotectin are the two best independent preoperative diagnostic tests for PJI. A cut off of 70% for synovial PMN% and tighter cut‐offs for synovial WBC and serum CRP could have a better diagnostic accuracy for non‐IA patients with chronic PJI.

show abstract

“…In recent years, synovial CRP has also been measured from synovial fluid samples in patients with suspected PJI. Despite initial promising reports, more recent studies have found that synovial CRP provides no additional benefit when compared to serum CRP in the diagnosis of PJI [ 80 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ].…”

Section: Diagnostic Testsmentioning

confidence: 99%

Diagnosis of Periprosthetic Joint Infection: The Utility of Biomarkers in 2023

et al. 2023

View full text Add to dashboard Cite

Periprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single “gold standard” test for the diagnosis of PJI. As a result, the diagnosis of PJI is often challenging. Currently, the 2018 ICM definition of PJI is the only validated diagnostic criteria available. This article will review the importance of serum and synovial biomarkers in the diagnosis of PJI. In addition, it will provide a brief overview of the emerging modalities for the identification of infections in this setting.

show abstract

Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study

Cited by 14 publications

References 24 publications

Predicting the Exception—CRP and Primary Hip Arthroplasty

Predicting the Exception—CRP and Primary Hip Arthroplasty

Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review

Diagnosis of Periprosthetic Joint Infection: The Utility of Biomarkers in 2023

Contact Info

Product

Resources

About