Zhao Mars Yixing, Girgis Samuel, Goldade Thomas, Parchomchuk Evan, Nickol Michaela, van der Merwe Johannes M
Department of Orthopaedic Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
JB JS Open Access. 2025 Apr 25;10(2). doi: 10.2106/JBJS.OA.24.00206. eCollection 2025 Apr-Jun.
Prompt diagnosis of periprosthetic joint infections (PJIs) is crucial for providing optimal care. Currently, there are no gold-standard tests available. An ideal test would be simple to implement, cost-effective, and readily available. We aimed to determine the best single or combined serological or synovial markers for diagnosing PJIs.
There were 177 of 313 patients who had PJIs between April 2012 and March 2023 and a control group of 60 patients who were included in this retrospective review. The PJIs were diagnosed using Musculoskeletal Infection Society (MSIS) and European Bone and Joint Infection Society (EBJIS) criteria. Serum (C-reactive protein [CRP], white blood-cell [WBC] count, neutrophil-lymphocyte ratio [NLR], polymorphonuclear neutrophil percentage [PMN%]), and synovial fluid (WBC, NLR, PMN%) parameters were compared between the 2 groups. We determined the sensitivity, specificity, area under the curve (AUC), and cutoff values (COV) for each marker. We determined the best combination of markers to diagnose PJIs. There was no statistical significance between the demographic data of the control and treatment groups.
The S-CRP had the highest AUC of 0.912 with a COV of 16.15 mg/dL (Sensitivity 79.6%, Specificity 97.8%). The combination of tests, S-CRP, synovial fluid (SF-WBC), and S-NLR demonstrated the highest AUC of 0.946 (Sensitivity 93%, Specificity 90.9%). The COV for SF-WBC was 5.75 cells/μL (AUC 0.803; Sensitivity 70.3%, Specificity 97.1%); S-NLR COV was 3.659 (AUC 0.803; Sensitivity 67.3%, Specificity 88%).
We found the combination of S-CRP, SF-WBC, and S-NLR to be valuable in diagnosing PJI with high sensitivities and specificities. It can be easily implemented by clinicians without additional cost or equipment. It is important to use this with a thorough clinical and physical examination as well as other modalities (i.e., MSIS/EBJIS criteria).
Retrospective Comparative Study-Level III evidence. See Instructions for Authors for a complete description of levels of evidence.
人工关节周围感染（PJI）的及时诊断对于提供最佳治疗至关重要。目前，尚无可用的金标准检测方法。理想的检测方法应易于实施、具有成本效益且随时可用。我们旨在确定用于诊断PJI的最佳单一或联合血清学或滑膜标志物。
在2012年4月至2023年3月期间，313例患有PJI的患者中有177例纳入本回顾性研究，并设立了一个由60例患者组成的对照组。PJI采用肌肉骨骼感染学会（MSIS）和欧洲骨与关节感染学会（EBJIS）的标准进行诊断。比较两组的血清（C反应蛋白[CRP]、白细胞[WBC]计数、中性粒细胞与淋巴细胞比值[NLR]、多形核中性粒细胞百分比[PMN%]）和滑液（WBC、NLR、PMN%）参数。我们确定了每个标志物的敏感性、特异性、曲线下面积（AUC）和临界值（COV）。我们确定了诊断PJI的最佳标志物组合。对照组和治疗组的人口统计学数据之间无统计学意义。
血清CRP（S-CRP）的AUC最高，为0.912，COV为16.15mg/dL（敏感性79.6%，特异性97.8%）。联合检测S-CRP、滑液（SF-WBC）和血清NLR（S-NLR）的AUC最高，为0.946（敏感性93%，特异性90.9%）。SF-WBC的COV为5.75个细胞/μL（AUC 0.803；敏感性70.3%，特异性97.1%）；S-NLR的COV为3.659（AUC 0.803；敏感性67.3%，特异性88%）。
我们发现S-CRP、SF-WBC和S-NLR的联合检测对于诊断PJI具有较高的敏感性和特异性，具有重要价值。临床医生可轻松实施，无需额外成本或设备。将其与全面的临床和体格检查以及其他方法（如MSIS/EBJIS标准）结合使用非常重要。
回顾性比较研究-III级证据。有关证据水平的完整描述，请参阅作者指南。
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