Department of Orthopaedics, The Affiliated Dazu Hospital of Chongqing Medical University, Chongqing, China; Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Arthroplasty. 2024 Aug;39(8):1932-1938. doi: 10.1016/j.arth.2024.04.054. Epub 2024 Apr 24.
A 2-stage exchange revision for periprosthetic joint infection (PJI) is associated with major risks for reinfection. Although serum markers are frequently used for diagnosis, their effectiveness remains debatable. Synovial fluid markers may offer a more accurate diagnosis of PJI; however, the importance of these biomarkers, notably synovial fluid C-reactive protein (syCRP), remains controversial, particularly in the context of reimplantation. The present study aimed to clarify these diagnostic uncertainties by evaluating the diagnostic efficacy of syCRP versus serum CRP (seCRP) levels in the context of PJI and recurring or persisting infections before reimplantation.
A total of 186 patients were enrolled and divided into 2 groups: aseptic revision (n = 112) and PJI revision (n = 74). Of the PJI group, 65 were categorized as success and 9 as failure, based on the presence of recurrent or persistent infection before reimplantation. The syCRP and seCRP levels and their changes were assessed preoperatively and in the first-stage and second-stage revisions. Additionally, receiver operating characteristic (ROC) curves and area under the ROC curves (AUCs) were analyzed.
Both seCRP and syCRP levels were significantly elevated in the PJI group compared with the aseptic group (P < .001). The ROC curve analysis highlighted the enhanced diagnostic accuracy of syCRP for PJI, with an AUC of 0.93 versus 0.80 for seCRP. Furthermore, syCRP proved to be more reliable in predicting reimplantation success, exhibiting an AUC of 0.86 versus 0.63 for seCRP. In evaluating trends in CRP levels to determine reimplantation timing, changes in syCRP levels demonstrated superior diagnostic utility, exhibiting an AUC of 0.79 versus 0.63 for changes in seCRP levels.
In assessing PJI and infections before reimplantation, syCRP may offer enhanced accuracy compared with seCRP. Nevertheless, variations in both syCRP and seCRP levels did not consistently predict the outcome of reimplantation.
对于假体周围关节感染（PJI），两阶段的翻修术与再次感染的重大风险相关。虽然血清标志物经常用于诊断，但它们的有效性仍存在争议。滑液标志物可能提供更准确的 PJI 诊断；然而，这些生物标志物，特别是滑液 C 反应蛋白（syCRP）的重要性，在再植入的背景下仍然存在争议。本研究旨在通过评估 PJI 和再植入前反复或持续感染时，syCRP 与血清 CRP（seCRP）水平的诊断效果，来澄清这些诊断不确定性。
共纳入 186 名患者，分为两组：无菌性翻修（n=112）和 PJI 翻修（n=74）。在 PJI 组中，根据再植入前是否存在反复或持续感染，将 65 例归为成功组，9 例归为失败组。评估了术前、第一阶段和第二阶段翻修时的 syCRP 和 seCRP 水平及其变化。此外，还分析了接收者操作特征（ROC）曲线和 ROC 曲线下面积（AUC）。
与无菌组相比，PJI 组的 seCRP 和 syCRP 水平均显著升高（P<0.001）。ROC 曲线分析突出了 syCRP 对 PJI 的诊断准确性更高，AUC 为 0.93，而 seCRP 为 0.80。此外，syCRP 更可靠地预测了再植入的成功，AUC 为 0.86，而 seCRP 为 0.63。在评估 CRP 水平变化以确定再植入时机时，syCRP 水平的变化显示出更好的诊断效用，AUC 为 0.79，而 seCRP 水平的变化为 0.63。
在评估 PJI 和再植入前的感染时，syCRP 可能比 seCRP 提供更高的准确性。然而，syCRP 和 seCRP 水平的变化并不总能预测再植入的结果。
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