Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study - 20/05/21
, Laura Gubbiotti a, Geoffrey Buia a, Valentin Chapus a, Julien Dunet a, Frederique Grandhomme b, Jocelyn Michon a, Goulven Rochcongar a, Christophe Hulet a
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Abstract |
Introduction |
The diagnosis of periprosthetic joint infection (PJI) can be challenging and rests on several principles. The use of diagnostic biomarkers, such as the synovial C-Reactive Protein (CRP), seems promising. The purpose of this study was to determine whether synovial CRP was a more discriminating test than serum CRP for the diagnosis of hip and knee PJI.
Materials and methods |
In total, 194 patients were included in this single center prospective study: 42 primary arthroplasties (control group [CG]), 111 revisions for aseptic prosthesis (aseptic revision group [ARG]), and 41 revisions for septic prosthesis (septic revision group [SRG]) based on the Musculoskeletal Infection Society (MSIS) criteria.
Results |
The serum and synovial CRP levels were significantly higher in the SRG than the other two groups (SRG serum CRP=75.6mg/L vs. ARG serum CRP=6mg/L and CG serum CRP=2.7mg/L, p<0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p<0.001). The positive likelihood ratios (LR+) were very similar for both the synovial CRP cut-off value of 4.4mg/L (LR+=7.04; sensitivity [Se] 82.5%, specificity [Sp] 88.3%) and the serum CRP cut-off value of 9mg/L (LR+=6.3; Se 87.5%, Sp 86.1%).
Conclusion |
This study showed that synovial CRP testing was not more discriminating than serum CRP in the diagnosis of hip and knee PJI. A serum CRP level greater than 9mg/L was a sign of PJI.
Level of evidence |
III; case-control study.
Le texte complet de cet article est disponible en PDF.Keywords : Periprosthetic joint infection, Hip prosthesis, Knee prosthesis, Serum CRP, Synovial CRP, Biomarkers of infection
Plan
Vol 107 - N° 4
Article 102903- juin 2021 Retour au numéro
Article précédent
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