Abstract
Background
Diagnosing a periprosthetic joint infection (PJI) is difficult and often requires
a combination of objective findings. The purpose of this study is to determine whether
platelets, a known acute phase reactant, would be able to further aid in the diagnosis
of PJI.
Methods
A single-institution retrospective review study was performed on all revision total
hip and knee arthroplasties done between 2000 and 2016 (n = 4939). PJI was defined
by Musculoskeletal Infection Society criteria (n = 949). Platelet count and mean platelet
volume were assessed from each patient’s preoperative complete blood count. These
values were then assessed as a ratio via receiver operating characteristic (ROC) curve
analysis.
Results
The platelet count to mean platelet volume ratio for PJI patients was 33.45 compared
to 25.68 for patients in the aseptic revision cohort (P < .001). ROC curve analysis demonstrates that a ratio of 31.70 has a sensitivity
of 48.10 (95% confidence interval 44.9-51.4) and a specificity of 80.85 (95% confidence
interval 79.6-82.1). This specificity was higher than that of both estimated sedimentation
ratio (ESR) and C-reactive protein (CRP) for the same cohorts using optimal values
determined via ROC curve analysis. When used in conjunction with ESR and CRP, there
was a statistically significant increase in the diagnostic performance of the model
used to assess PJI relative to the model that just employed ESR and CRP (P < .05).
Conclusion
Our study demonstrates that platelets and their associated serum biomarkers are associated
with PJI and warrant consideration in patients who are being evaluated for potential
PJI.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnosis of periprothestic joint infection: the threshold for serological markers.Clin Orthop Relat Res. 2013; 471: 3186-3195
- The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria.J Arthroplasty. 2018; 33: 1309-1314
- Changes in platelet count and mean platelet volume during infectious and inflammatory disease and their correlation with ESR and CRP.J Clin Lab Anal. 2014; 28: 245-248
- Potential role of interleukin-6 in reactive thrombocytosis and acute phase response in pulmonary tuberculosis.Postgrad Med J. 2005; 81: 604-607
- Effects of interleukin-1 and tumor necrosis factor on megakaryocytopoiesis: mechanism of reactive thrombocytosis.Acta Hematol. 1995; 93: 67-72
- Mean platelet volume changes in infection.J Clin Pathol. 1983; 36: 1320-1321
- Migrating platelets are mechano-scavengers that collect and bundle bacteria.Cell. 2017; 171: 1368-1382
- Role of blood platelets in infection and inflammation.J Interferon Cytokine Res. 2002; 22: 913-922
- Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation.J Bone Joint Surg Am. 2017; 99: 1419
- The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: a systematic review and meta-analysis.J Bone Joint Surg Am. 2016; 98: 992
- Leukocyte esterase strip test: matched for musculoskeletal infection society criteria.J Bone Joint Surg Am. 2014; 96: 1917
- Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme.J Bone Joint Surg Am. 2011; 93: 2242-2248
- Combined measurement of synovial fluid α-defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection.J Bone Joint Surg Am. 2014; 96: 1439
- Qualitative α-defensin test (Synovasure) for the diagnosis of periprosthetic infection in revision total joint arthroplasty.Bone Joint J. 2017; 99-B: 66
- Diagnosis of periprosthetic joint infection: the potential of next-generation sequencing.J Bone Joint Surg Am. 2018; 100: 147
- Advancements in diagnosing periprosthetic joint infections after total hip and knee arthroplasty.Open Orthop J. 2016; 10: 654
- Diagnosing periprosthetic joint infection: has the era of the biomarker arrived?.Clin Orthop Relat Res. 2014; 472: 3254
- Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.J Bone Joint Surg Am. 2017; 99: 2077
- Abnormally high, as well as low, preoperative platelet counts correlate with adverse outcomes and readmissions after elective total knee arthroplasty.J Arthroplast. 2019; 34: 1670-1676
- Fibrinogen—a practical and cost efficient biomarker for detecting periprosthetic joint infection.Sci Rep. 2018; 8: 8802
- Investigation of inflammatory and hemostatic parameters in female patients undergoing total knee arthroplasty surgery.Inflammation. 2008; 31: 414-421
- Plasma fibrinogen exhibits better performance than plasma D-dimer in the diagnosis of periprosthetic joint infection: a multicenter retrospective study.J Bone Joint Surg Am. 2019; 101: 613-619
- Automated platelet-sizing parameters on a normal population.Am J Clin Pathol. 1987; 87: 365-369
- Platelet counts differ by sex, ethnicity, and age in the United States.Ann Epidemiol. 2006; 16: 123-130
- Analysis of 12,517 inhabitants of a Sardinian geographic isolate reveals that predispositions to thrombocytopenia and thrombocytosis are inherited traits.Haematologica. 2011; 96: 96-101
Article Info
Publication History
Published online: October 15, 2019
Accepted:
October 6,
2019
Received in revised form:
August 5,
2019
Received:
May 13,
2019
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.10.012.
Identification
Copyright
© 2019 Published by Elsevier Inc.
