Herman Amir, Albers Anthony, Garbuz Donald S, Duncan Clive P, Masri Bassam A
Orthopedics. 2019 Jan 1;42(1):34-40. doi: 10.3928/01477447-20190103-03.
Two-stage exchange arthroplasty remains the treatment of choice for chronic periprosthetic joint infections. This retrospective study conducted between 2009 and 2015 examined the diagnostic value of biomarkers for residual infection between stages. The biomarkers evaluated included C-reactive protein prior to reimplantation, preimplantation synovial fluid white blood cell count and percent neutrophils, and the intraoperative histologic synovial white blood cell count per high-power field (×400) on permanent sections. Residual infection was defined as either positive cultures (more than 1) at second stage, any further surgery (eg, amputation, arthrodesis, or another 2-stage revision), or the need for infection suppression with antibiotics. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated accordingly. A total of 182 two-stage exchange operations that included 109 (59.9%) prosthetic hips and 73 (40.1%) prosthetic knees met the inclusion criteria. Residual infection was present in 38 (20.9%) of the procedures. The area under the curve-receiver operating characteristic values were 0.677 for C-reactive protein (P=.002), 0.506 for aspiration white blood cell count (P=.944), 0.623 for aspiration percent neutrophils (P=.200), and 0.524 for white blood cell count per high-power field (P=.801). Positive and negative predictive values were poor and ranged between 26% and 57% and 78% and 85%, respectively. Analyses using specific combinations of biomarkers did not significantly improve predictive values. This study showed that classic markers perform poorly in identifying residual infection prior to second-stage revision. Further research is necessary to evaluate the diagnostic utility of other, more recently introduced biomarkers to determine whether infection has been eradicated between stages. [Orthopedics. 2019; 42(1):34-40.].
两阶段关节置换术仍是慢性人工关节周围感染的首选治疗方法。这项在2009年至2015年期间进行的回顾性研究，探讨了生物标志物对两阶段之间残余感染的诊断价值。评估的生物标志物包括再植入前的C反应蛋白、植入前滑液白细胞计数和中性粒细胞百分比，以及永久切片上每高倍视野（×400）的术中组织学滑膜白细胞计数。残余感染定义为第二阶段培养阳性（超过1次）、任何进一步的手术（如截肢、关节融合或另一次两阶段翻修），或需要使用抗生素抑制感染。相应地计算了敏感性、特异性、阳性和阴性预测值以及似然比。共有182例两阶段置换手术符合纳入标准，其中包括109例（59.9%）人工髋关节和73例（40.1%）人工膝关节。38例（20.9%）手术存在残余感染。C反应蛋白的曲线下面积-受试者操作特征值为0.677（P = 0.002），穿刺白细胞计数为0.506（P = 0.944），穿刺中性粒细胞百分比为0.623（P = 0.200），每高倍视野白细胞计数为0.524（P = 0.801）。阳性和阴性预测值较差，分别在26%至57%和78%至85%之间。使用生物标志物的特定组合进行分析并未显著提高预测值。这项研究表明，经典标志物在识别第二阶段翻修前的残余感染方面表现不佳。有必要进一步研究评估其他最近引入的生物标志物的诊断效用，以确定两阶段之间感染是否已根除。[《骨科》。2019年；42(1):34 - 40。]
