Unreliability of Serum- or Plasma-based Assays of D-dimer or Fibrin (Fibrinogen) Degradation Product for Diagnosing Periprosthetic Joint Infection: A Prospective Parallel Study

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2023 Nov 17

PMID 37975182

Authors

Hong Xu

Jing Zhou

Qiang Huang

Zeyu Huang

Jinwei Xie

Zongke Zhou

Affiliations

Soon will be listed here.

Abstract

Objective: The ability of D-dimer to diagnose periprosthetic joint infection (PJI) before revision hip or knee arthroplasty is still controversial, and the differences in diagnostic ability between serum- or plasma-based assays of D-dimer and fibrin (fibrinogen) degradation product (FDP) are uncertain. The prospective parallel study was performed to determine the ability of D-dimer to diagnose PJI before revision hip or knee arthroplasty, and the differences in diagnostic ability between serum- or plasma-based assays of D-dimer and FDP.

Methods: Patients undergoing knee or hip arthroplasty at our institution were prospectively enrolled into the following groups: those without inflammatory diseases who were undergoing primary arthroplasty ("Prim" group), those with inflammatory arthritis who were undergoing primary arthroplasty ("Prim/Inflam"), those undergoing revision arthroplasty because of aseptic failure ("Rev/Asept"), or those undergoing revision arthroplasty because of PJI ("Rev/PJI"). The ability of preoperative levels of D-dimer or FDP in serum or plasma to diagnose PJI in each group was assessed using areas under receiver operating characteristic curves (AUCs) and other diagnostic performance indicators. The diagnostic performance of these assays was compared with that of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Results: In the final analysis, Prim included 42 patients; Prim/Inflam, 40; Rev./Asept, 62; and Rev./PJI, 47. D-dimer assays led to AUCs of 0.635 in serum and 0.573 in plasma, compared to 0.593 and 0.607 for FDP. Even in combination with CRP or ESR, these assays failed to perform as well as the combination of CRP and ESR for diagnosing PJI.

Conclusion: Levels of D-dimer or FDP in serum or plasma, whether used alone or together with CRP or ESR, are unreliable for diagnosing PJI before revision arthroplasty.

Citing Articles

Are Red Blood Cell Distribution Width and Platelet Count Useful for Diagnosing Periprosthetic Joint Infection in Patients Undergoing Re-Revision Arthroplasty.

Zhang Y, Xie Q, Jiang B, Jiang W, Xu H, Zhou Z Orthop Surg. 2024; 16(12):2916-2923.

PMID: 39354799 PMC: 11608779. DOI: 10.1111/os.14219.

References

Pannu T, Villa J, Manrique J, Higuera C, Riesgo A . Paradoxical Behavior of Plasma d-Dimer From Explantation to Reimplantation in a Two-Stage Revision for Periprosthetic Joint Infection. J Arthroplasty. 2022; 37(8S):S977-S982. DOI: 10.1016/j.arth.2022.02.023. View

Shahi A, Kheir M, Tarabichi M, S Hosseinzadeh H, Tan T, Parvizi J . Serum D-Dimer Test Is Promising for the Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation. J Bone Joint Surg Am. 2017; 99(17):1419-1427. DOI: 10.2106/JBJS.16.01395. View

Li R, Song L, Quan Q, Liu M, Chai W, Lu Q . Detecting Periprosthetic Joint Infection by Using Mass Spectrometry. J Bone Joint Surg Am. 2021; 103(20):1917-1926. DOI: 10.2106/JBJS.20.01944. View

Li C, Margaryan D, Ojeda-Thies C, Perka C, Trampuz A . Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection. J Orthop Surg Res. 2020; 15(1):298. PMC: 7409706. DOI: 10.1186/s13018-020-01808-1. View

Shohat N, Goswami K, Fillingham Y, Tan T, Calkins T, Della Valle C . Diagnosing Periprosthetic Joint Infection in Inflammatory Arthritis: Assumption Is the Enemy of True Understanding. J Arthroplasty. 2018; 33(11):3561-3566. DOI: 10.1016/j.arth.2018.07.016. View

Fujimoto T, Kaneko T, Sunakawa T, Ikegami H, Musha Y . Elevation of fibrin degradation product (FDP) values prevents the negative conversion of serum CRP values after total knee arthroplasty. J Orthop. 2018; 15(4):940-944. PMC: 6128171. DOI: 10.1016/j.jor.2018.08.005. View

Saleh A, George J, Faour M, Klika A, Higuera C . Serum biomarkers in periprosthetic joint infections. Bone Joint Res. 2018; 7(1):85-93. PMC: 5805828. DOI: 10.1302/2046-3758.71.BJR-2017-0323. View

Fehring T, Odum S, Berend K, Jiranek W, Parvizi J, Bozic K . Failure of irrigation and débridement for early postoperative periprosthetic infection. Clin Orthop Relat Res. 2012; 471(1):250-7. PMC: 3528942. DOI: 10.1007/s11999-012-2373-9. View

Pannu T, Villa J, Jimenez D, Riesgo A, Higuera C . Does Performance of D-Dimer for Diagnosis of Periprosthetic Joint Infection Change With the Virulence of Infecting Organism?. J Arthroplasty. 2023; 38(7 Suppl 2):S389-S393. DOI: 10.1016/j.arth.2023.05.022. View

10.

Ribera T, Monreal L, Armengou L, Rios J, Prades M . Synovial fluid D-dimer concentration in foals with septic joint disease. J Vet Intern Med. 2011; 25(5):1113-7. DOI: 10.1111/j.1939-1676.2011.0758.x. View

11.

Yokomichi A, Rodrigues V, Moroz A, Bertanha M, Ribeiro S, Deffune E . Detection of factor VIII and D-dimer biomarkers for venous thromboembolism diagnosis using electrochemistry immunosensor. Talanta. 2020; 219:121241. DOI: 10.1016/j.talanta.2020.121241. View

12.

Xu H, Xie J, Yang J, Huang Z, Pei F . Role of D-dimer and Fibrinogen in the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis. Orthop Surg. 2021; 13(3):692-700. PMC: 8126916. DOI: 10.1111/os.12969. View

13.

Lee Y, Lee Y, Han S, Nam C, Parvizi J, Koo K . Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection. J Orthop Surg Res. 2018; 13(1):36. PMC: 5811971. DOI: 10.1186/s13018-018-0730-4. View

14.

Shi D, Xia T, Feng H, Cheng Q . Evaluating the diagnostic value of vWF:Ag, D-D and FDP in patients with acute cerebral infarction using ROC curves. Exp Ther Med. 2014; 7(6):1573-1577. PMC: 4043620. DOI: 10.3892/etm.2014.1665. View

15.

Delanois R, Mistry J, Gwam C, Mohamed N, Choksi U, Mont M . Current Epidemiology of Revision Total Knee Arthroplasty in the United States. J Arthroplasty. 2017; 32(9):2663-2668. DOI: 10.1016/j.arth.2017.03.066. View

16.

Xu H, Xie J, Huang Q, Lei Y, Zhang S, Pei F . Plasma Fibrin Degradation Product and D-Dimer Are of Limited Value for Diagnosing Periprosthetic Joint Infection. J Arthroplasty. 2019; 34(10):2454-2460. DOI: 10.1016/j.arth.2019.05.009. View

17.

Gando S . Role of fibrinolysis in sepsis. Semin Thromb Hemost. 2013; 39(4):392-9. DOI: 10.1055/s-0033-1334140. View

18.

Kanafani Z, Sexton D, Pien B, Varkey J, Basmania C, Kaye K . Postoperative joint infections due to Propionibacterium species: a case-control study. Clin Infect Dis. 2009; 49(7):1083-5. DOI: 10.1086/605577. View

19.

Ali F, Wilkinson J, Cooper J, Kerry R, Hamer A, Norman P . Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty. J Arthroplasty. 2006; 21(2):221-6. DOI: 10.1016/j.arth.2005.05.027. View

20.

Parvizi J, Gehrke T . Definition of periprosthetic joint infection. J Arthroplasty. 2014; 29(7):1331. DOI: 10.1016/j.arth.2014.03.009. View