CORR Insights^®: Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Excerpt

Periprosthetic joint infections (PJIs) are expensive, difficult to treat, and devastating to patients. Despite the presence of consensus guidelines on the diagnosis of PJI [1, 2, 8], preoperative differentiation between PJI and aseptic failure remains a challenge, mainly because of the relatively low negative predictive value of routinely available clinical tests for patients deemed at risk. Those tests include synovial fluid cell count and C-reactive protein (CRP) analysis. Because preoperative exclusion of PJI substantially alters surgical planning, we need to produce better preoperative diagnostic tests for PJI. Among the novel molecular and immunologic tests undergoing evaluation, synovial fluid CRP has shown promise in diagnosing PJI in previous preliminary studies [3, 4, 6, 7]. C-reactive protein is a nonspecific acute phase reactant synthesized by the liver, and should be present in synovial fluid in response to PJI secondary to translocation from blood through inflamed and leaky capillaries. …