Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Otwock, Poland.
Idea Ortopedia, Warsaw, Poland.
Adv Clin Exp Med. 2024 May;33(5):543-548. doi: 10.17219/acem/186958.
Recent studies have revealed the usefulness of synovial calprotectin (CLP) in diagnosing chronic periprosthetic joint infections (PJIs). However, there is still a lack of evidence to support the use of serum CLP in the diagnosis of early PJIs and surgical site infections (SSIs) after total joint arthroplasties (TJAs).
The primary aim of this study is to investigate the standard kinetics of CLP concentrations in the blood during the very early postoperative period after non-complicated total hip arthroplasty (THA) and total knee arthroplasty (TKA). The secondary aim was to perform a preliminary comparison of CLP concentrations between non-infected patients and patients with recognized SSIs.
A total of 64 consecutive patients who underwent primary THA and TKA were included in this prospective research. Sixty patients (30 THA and 30 TKA) were scheduled to determine the standard shape of the blood CLP curve and the expected concentrations during the first 5 postoperative days after non-complicated TJAs. In 4 additonal patients, early SSI was confirmed, and they were included in a separate SSI subgroup.
Calprotectin demonstrated a linear increase during the first 5 postoperative days. Statistically significant differences in CLP concentrations between non-infected cases and SSIs were not observed. The preoperative median results with interquartile range (Q1-Q3) were 0.52 (0.39-0.64) mg/dL and 0.5 (0.47-0.52) mg/dL (p = 0.77), while post operation they were as follows: on postoperative day 1: 0.88 (0.53-1.3) mg/dL and 0.86 (0.62-1.1) mg/dL (p = 0.84), on postoperative day 3: 1.77 (1.29-2.08) mg/dL and 1.85 (1.70-1.95) mg/dL (p = 0.72), and on postoperative day 5: 2.32 (1.79-2.67) mg/dL and 2.56 (2.25-2.83) mg/dL (p = 0.55), respectively.
Serial CLP measurements during the early postoperative period revealed a linear (statistically significant) increase in concentration to postoperative day 5 without an evident point of decrease. A significant difference in median values and the course of curve patterns between the non-complicated and SSI groups was not observed.
最近的研究表明，滑膜钙卫蛋白（CLP）在诊断慢性人工关节周围感染（PJI）方面具有一定的作用。然而，目前尚无证据支持在初次全关节置换术后（TJA）早期及手术部位感染（SSI）的情况下使用血清 CLP 进行诊断。
本研究旨在初步探讨无并发症的全髋关节置换术（THA）和全膝关节置换术（TKA）后非常早期的血液 CLP 浓度的标准动力学。次要目的是对无感染患者与确诊为 SSI 的患者之间的 CLP 浓度进行初步比较。
本前瞻性研究共纳入 64 例连续接受初次 THA 和 TKA 的患者。其中 60 例（30 例 THA 和 30 例 TKA）用于确定无并发症 TJA 后前 5 天的血液 CLP 曲线的标准形态和预期浓度。另外 4 例患者发生早期 SSI，他们被归入单独的 SSI 亚组。
CLP 浓度在术后第 1 天至第 5 天呈线性增加。未观察到无感染病例和 SSI 之间的 CLP 浓度存在统计学差异。术前中位数（四分位距[Q1-Q3]）分别为 0.52（0.39-0.64）mg/dL 和 0.50（0.47-0.52）mg/dL（p=0.77），术后结果如下：术后第 1 天：0.88（0.53-1.3）mg/dL 和 0.86（0.62-1.1）mg/dL（p=0.84），术后第 3 天：1.77（1.29-2.08）mg/dL 和 1.85（1.70-1.95）mg/dL（p=0.72），术后第 5 天：2.32（1.79-2.67）mg/dL 和 2.56（2.25-2.83）mg/dL（p=0.55）。
在术后早期进行连续的 CLP 测量显示，浓度呈线性（具有统计学意义）增加，直至术后第 5 天，无明显的下降点。在无并发症组和 SSI 组之间，中位数和曲线形态的差异没有统计学意义。
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