ArticleJournal of orthopaedic surgery and research2019
Can we rely on the combination of serological tests and frozen sections at the time of reimplantation for two-stage exchange hip arthroplasty in patients with a "dry tap"?
Article in Journal of orthopaedic surgery and research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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2 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Identifying potential predictive indicators for reimplantation timing in two-stage revision: a meta-analysis and system review.Archives of orthopaedic and trauma surgery · 2024Pooled it
- Does serum interleukin-6 guide the diagnosis of persistent infection in two-stage hip revision for periprosthetic joint infection?Journal of orthopaedic surgery and research · 2019Article
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3 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
purposeThe optimal timing of reimplantation of two-stage exchange arthroplasty for periprosthetic joint infection remains unknown. The purpose of the study was to (1) evaluate performance of combination of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and frozen section in predicting persistent infection at the time of second-stage hip reimplantation and (2) compare accuracies of 5 and 10 polymorphonuclear neutrophils (PMNs) per high power field (HPF) as the threshold of frozen section.
methodsWe retrospectively reviewed 97 two-stage exchange hip arthroplasties from 2012-2016. Persistent infection at time of reimplantation was diagnosed using the Musculoskeletal Infection Society (MSIS) criteria. Two diagnostic models were developed. Model 1 utilized ESR, CRP, and > 5 PMNs/HPF on frozen section. Model 2 utilized ESR, CRP, and > 10 PMNs/HPF. Receiver operating characteristic (ROC) curves of the two models were generated, and areas under the curves (AUCs) were compared. A set of sensitivity analysis, using the Delphi-based consensus criteria for treatment success, was conducted to verify the accuracy of our models.
resultsThe overall rate of infection at reimplantation was 14.4%. AUCs for models 1 and 2 were 0.709 (95% confidence interval [CI], 0.557-0.852) and 0.697 (95% CI, 0.529-0.847), respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 57.1%, 88.0%, 44.4%, and 92.4%, respectively, in model 1 and 42.9%, 96.4%, 66.7%, and 90.9%, respectively, in model 2. Models 1 and 2 had no significant difference in predictive values (p = 0.821). Results remained robust in the sensitivity analysis.
conclusionsThis study reveals that the combination of serum ESR, CRP, and frozen section has limited diagnostic value in predicting persistent infection at reimplantation. Additionally, no significant difference in accuracies between 5 and 10 PMNs/HPF as the threshold of frozen section were found. There is a need for timely biomarkers with higher accuracy in diagnosing infection before reimplantation.
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