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Serum D-dimer levels may be a reliable test for diagnosis of periprosthetic joint infection
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Diagnosis of periprosthetic joint infection is still a challenge due to a lack of an absolute test. When a clinician encounters a suspected periprosthetic joint infection case, he or she has to use a combination of tests, all of which can be invasive and expensive. Even with a combination of tests, it is difficult to reach a firm diagnosis in many cases.
While synovial fluid markers have shown a promising diagnostic role, obtaining synovial fluid sample is troublesome. Joint aspiration carries risk of introducing infection to the joint, an area not always easy to access. Aspiration of the joint is invasive and sometimes the aspiration may not yield adequate joint fluid for analyses.
Serum D-dimer levels
Clinicians have been searching for a reliable serum marker. A recent study from our institution shows serum D-dimer levels may be a reliable test for diagnosis of periprosthetic joint infection (PJI) and, most importantly, for determining the optimal timing of reimplantation for patients undergoing two-stage exchange arthroplasty. D-dimer is a fibrin degradation product and the serum levels indicate fibrinolytic activities. Several studies have demonstrated fibrin deposits in joints follow an inflammatory reaction, mainly due to an increase in the permeability of the inflamed synovium and local extravasation of plasma fibrinogen.
Alisina Shahi
Javad Parvizi
We initiated a prospective study in our institution to examine whether serum D-dimer levels are increased in patients with PJI. All total joint arthroplasty patients were enrolled. After excluding patients with a history of cancer, venous thrombosis, systemic inflammatory disease and active ulcer, 95 patients (including 27 patients with PJI) have been recruited.
D-dimer levels in the four study groups are shown. The D-dimer threshold is indicated with the dotted line (750 ng/mL). Bars represent mean and 95% confidence intervals in each group.
Image: Shahi A
Threshold for diagnosis
The D-dimer threshold for the diagnosis of PJI was calculated using Youden’s index (D-dimer greater than 750 ng/mL). Serum D-dimer showed promising results for the diagnosis of PJI with no false negatives. Two false positives were found in the revision group, both of which were revised due to dislocation (Figure).
Based on the data from this ongoing study, it appears the serum D-dimer could be a promising marker for diagnosing PJI, especially for screening suspected patients. It also may have a great utility for determining the optimal timing of reimplantation and infection eradication. While this study will continue to recruit more patients and collect more data, it appears a reliable serum marker for infection may be here.
- References:
- Camerer E, et al. Thromb Res. 1996;81:1-41.
- So AK, et al. J Thromb Haemost. 2003;1:2510-2515.
- For more information:
- AliSina Shahi, MD, and Javad Parvizi, MD, FRCS, can be reached at The Rothman Institute at Thomas Jefferson University Hospital, Sheridan Building, Suite 1000, 125 S. 9th St., Philadelphia, PA 19107; emails: ali.sinair@gmail.com and parvj@aol.com.
Disclosures: Shahi reports no relevant financial disclosures. Parvizi reports he is a consultant to Zimmer Biomet, Ceramtec, Convatec and TissueGene; and has ownership in CD Diagnostics, Hip Innovation Technology, ForMD, Alphaeon and Joint Purification Systems.