Synovial biomarkers may not predict failure after reimplantation
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Results presented at the Musculoskeletal Infection Society Annual Meeting showed synovial biomarkers did not demonstrate high prognostic utility for predicting failure following reimplantation.
“This study adds to the literature setting that there is limited availability of accurate markers that can predict reimplantation,” Saad Tarabichi, MD, a postdoctoral research fellow at Rothman Orthopaedic Institute, said in his presentation. “Synovial [C-reactive protein] CRP may be promising to detect infection eradication and control, but further research is needed. Future research should focus on the utility or discovery of newer synovial markers to assess infection eradication following a two-stage protocol.”
Tarabichi and colleagues recorded patient demographics, American Society of Anesthesiologists (ASA) score, time to reimplantation, need for chronic antibiotic suppression, postsurgical outcomes and complications, and mortality among 108 patients who underwent joint aspiration prior to hip or knee reimplantation and had a minimum of 1-year follow-up. Researchers also recorded the results of synovial white blood cell count, synovial polymorphonuclear leukocyte percentage, synovial CRP and alpha defensin. Tarabichi noted receiver operating characteristic curves were used to assess the prognostic accuracy of the different markers and appropriate statistical analysis was performed when necessary.
“We had 25 patients who failed treatment, with the average time to failure being about 18 months,” Tarabichi said. “The time from aspiration to reimplantation was about a month, and we saw no difference in baseline characteristics, ASA scores and time to reimplantation between the two groups.”
Area under the curve showed white blood cell count, polymorphonuclear leukocyte percentage and alpha defensin had poor diagnostic utility, according to Tarabichi. Although synovial CRP had slightly better diagnostic utility at 0.64, Tarabichi noted no statistically significant differences between the levels in the treatment success and failure groups.
“The levels between the treatment success and failure groups were not statistically significant and, in the case of synovial CRP, I think this was likely due to a small sample size,” Tarabichi said.
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Tarabichi S, et al. Paper 932. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 5-6, 2022; Pittsburgh (hybrid meeting).
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