Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2021 | Wound Debridement | Research

The role of fibrinogen in predicting reinfection after DAIR for periprosthetic joint infections

Authors: Dacheng Zhao, Jinwen He, Xingwen Wang, Xiaobing Zhao, Yayi Xia, Bin Geng

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

Abstract

Background

Fibrinogen (FIB) has been found to be a promising marker in diagnosing periprosthetic joint infection (PJI), however, the value of FIB in predicting reinfection of PJI is unknown. The purpose of this study was to evaluate the value of FIB in predicting reinfection after debridement, antibiotics, and implant retention (DAIR) for PJI.

Methods

We retrospectively analyzed the clinical data of patients who were diagnosed with PJI and underwent DAIR from 2013 to 2019. The levels of the FIB, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured before DAIR. After DAIR, patients were followed and reinfections were identified. For both acute and chronic PJI, the predictive value of FIB was evaluated by calculating the sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic curve (ROC), and was compared with traditional inflammatory markers including ESR and CRP.

Results

The expression of FIB differed between patients reinfected and those not reinfected in both acute and chronic PJI (p < 0.05). In patients who underwent DAIR for acute PJI, the sensitivity and specificity of FIB were 81.82 and 83.33%, respectively, which were significantly higher than that of CRP (sensitivity, 72.73%; specificity, 50%; p < 0.05), while the specificity was higher than that of ESR (specificity, 41.67%; p < 0.05). In patients who underwent DAIR for chronic PJI, the sensitivity and specificity of FIB were 80.00 and 66.66%, respectively, which were significantly higher than that of CRP (sensitivity, 53.33%; specificity, 66.66%; p < 0.05) and ESR (sensitivity was 66.00%; specificity, 16.66%; p < 0.05). The ROC curves showed that FIB demonstrated the highest AUC among the biomarkers in both acute and chronic PJI.

Conclusion

FIB is a promising indicator in predicting reinfection after DAIR for both acute and chronic PJI, and it seems to perform better than ESR and CRP.

Available only for authorised users

Parvizi J, Shohat N, Gehrke T. Prevention of periprosthetic joint infection: new guidelines. Bone Joint J. 2017;99-b(4 Supple B):3–10.CrossRef

Achermann Y, Stasch P, Preiss S, Lucke K, Vogt M. Characteristics and treatment outcomes of 69 cases with early prosthetic joint infections of the hip and knee. Infection. 2014;42(3):511–9. https://doi.org/10.1007/s15010-014-0584-6.CrossRefPubMed

Di Benedetto P, Di Benedetto ED, Salviato D, Beltrame A, Gissoni R, Cainero V, et al. Acute periprosthetic knee infection: is there still a role for DAIR? Acta Biomed. 2017;88(2s):84–91. https://doi.org/10.23750/abm.v88i2-S.6518.CrossRefPubMedPubMedCentral

Sherrell JC, Fehring TK, Odum S, Hansen E, Zmistowski B, Dennos A, et al. The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and débridement for periprosthetic knee infection. Clin Orthop Relat Res. 2011;469(1):18–25. https://doi.org/10.1007/s11999-010-1434-1.CrossRefPubMed

Tan TL, Goswami K, Fillingham YA, Shohat N, Rondon AJ, Parvizi J. Defining treatment success after 2-stage exchange arthroplasty for periprosthetic joint infection. J Arthroplast. 2018;33(11):3541–6. https://doi.org/10.1016/j.arth.2018.06.015.CrossRef

Kuo FC, Goswami K, Shohat N, Blevins K, Rondon AJ, Parvizi J. Two-stage exchange arthroplasty is a favorable treatment option upon diagnosis of a fungal periprosthetic joint infection. J Arthroplast. 2018;33(11):3555–60. https://doi.org/10.1016/j.arth.2018.07.024.CrossRef

Löwik CM, Parvizi J, Jutte PC, Zijlstra WP, Knobben BaS XC, et al. Debridement, antibiotics, and implant retention is a viable treatment option for early periprosthetic joint infection presenting more than 4 weeks after index arthroplasty. Clin Infect Dis. 2020;71(3):630–6. https://doi.org/10.1093/cid/ciz867.CrossRefPubMed

Lora-Tamayo J, Murillo O, Iribarren JA, Soriano A, Sánchez-Somolinos M, Baraia-Etxaburu JM, et al. A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis. 2013;56(2):182–94. https://doi.org/10.1093/cid/cis746.CrossRefPubMed

Rodríguez-Pardo D, Pigrau C, Lora-Tamayo J, Soriano A, Del Toro MD, Cobo J, et al. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect. 2014;20(11):O911–9. https://doi.org/10.1111/1469-0691.12649.CrossRefPubMed

10.

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):940–4. https://doi.org/10.1016/j.jor.2018.08.005.CrossRefPubMedPubMedCentral

11.

Stambough JB, Curtin BM, Odum SM, Cross MB, Martin JR, Fehring TK. Does change in ESR and CRP guide the timing of two-stage arthroplasty reimplantation? Clin Orthop Relat Res. 2019;477(2):364–71. https://doi.org/10.1097/01.blo.0000533618.31937.45.CrossRefPubMed

12.

Schiffner E, Latz D, Thelen S, Grassmann JP, Karbowski A, Windolf J, et al. Normal CRP and WBC values in total hip arthroplasty (THA) with signs of loosening. Do we need a joint aspiration? J Clin Orthop Trauma. 2019;10(3):566–70. https://doi.org/10.1016/j.jcot.2018.09.011.CrossRefPubMed

13.

Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplast. 2014;29(7):1331. https://doi.org/10.1016/j.arth.2014.03.009.CrossRef

14.

Bin G, Xinxin Y, Fan L, Shenghong W, Yayi X. Serum fibrinogen test performs well for the diagnosis of periprosthetic joint infection. J Arthroplast. 2020;35(9):2607–12. https://doi.org/10.1016/j.arth.2020.04.081.CrossRef

15.

Klim SM, Amerstorfer F, Gruber G, Bernhardt GA, Radl R, Leitner L, et al. Fibrinogen - a practical and cost efficient biomarker for detecting periprosthetic joint infection. Sci Rep. 2018;8(1):8802. https://doi.org/10.1038/s41598-018-27198-3.CrossRefPubMedPubMedCentral

16.

Zhang Q, Dong J, Zhou D, Liu F. Circulating D-dimer versus fibrinogen in the diagnosis of peri-prosthetic joint infection: a meta-analysis. Surg Infect. 2021;22(2):200–10. https://doi.org/10.1089/sur.2019.298.CrossRef

17.

Shahi A, Kheir MM, Tarabichi M, Hosseinzadeh HRS, Tan TL, 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):1419–27. https://doi.org/10.2106/JBJS.16.01395.CrossRefPubMed

18.

Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309–14.e2.CrossRef

19.

Li R, Shao HY, Hao LB, Yu BZ, Qu PF, Zhou YX, et al. 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(7):613–9. https://doi.org/10.2106/JBJS.18.00624.CrossRefPubMed

20.

Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res. 2011;469(11):2992–4. https://doi.org/10.1007/s11999-011-2102-9.CrossRefPubMedPubMedCentral

21.

Argenson JN, Arndt M, Babis G, Battenberg A, Budhiparama N, Catani F, et al. Hip and knee section, treatment, debridement and retention of implant: proceedings of international consensus on orthopedic infections. J Arthroplast. 2019;34(2s):S399–s419. https://doi.org/10.1016/j.arth.2018.09.025.CrossRef

22.

Gramlich Y, Johnson T, Kemmerer M, Walter G, Hoffmann R, Klug A. Salvage procedure for chronic periprosthetic knee infection: the application of DAIR results in better remission rates and infection-free survivorship when used with topical degradable calcium-based antibiotics. Knee Surg Sports Traumatol Arthrosc. 2020;28(9):2823–34. https://doi.org/10.1007/s00167-019-05627-8.CrossRefPubMed

23.

Maier SP, Klemt C, Tirumala V, Oganesyan R, Van Den Kieboom J, Kwon YM. Elevated ESR/CRP ratio is associated with reinfection after debridement, antibiotics, and implant retention in chronic periprosthetic joint infections. J Arthroplast. 2020;35(11):3254–60. https://doi.org/10.1016/j.arth.2020.06.007.CrossRef

24.

Kuiper JW, Vos SJ, Saouti R, Vergroesen DA, Graat HC, Debets-Ossenkopp YJ, et al. Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthop. 2013;84(4):380–6. https://doi.org/10.3109/17453674.2013.823589.CrossRefPubMedPubMedCentral

25.

Ishii Y, Noguchi H, Takeda M, Sato J, Takayama S, Toyabe S. Characteristics and significance of fever during 4 weeks after primary total knee arthroplasty. Arch Orthop Trauma Surg. 2014;134(5):707–12. https://doi.org/10.1007/s00402-014-1949-0.CrossRefPubMedPubMedCentral

26.

Dupont C, Rodenbach J, Flachaire E. The value of C-reactive protein for postoperative monitoring of lower limb arthroplasty. Ann Readapt Med Phys. 2008;51(5):348–57. https://doi.org/10.1016/j.annrmp.2008.01.014.CrossRefPubMed

27.

Klim SM, Amerstorfer F, Glehr G, Hauer G, Smolle MA, Leitner L, et al. Combined serum biomarker analysis shows no benefit in the diagnosis of periprosthetic joint infection. Int Orthop. 2020;44(12):2515–20. https://doi.org/10.1007/s00264-020-04731-6.CrossRefPubMedPubMedCentral

28.

Koyonos L, Zmistowski B, Della Valle CJ, Parvizi J. Infection control rate of irrigation and débridement for periprosthetic joint infection. Clin Orthop Relat Res. 2011;469(11):3043–8. https://doi.org/10.1007/s11999-011-1910-2.CrossRefPubMedPubMedCentral

29.

Tornero E, Martínez-Pastor JC, Bori G, García-Ramiro S, Morata L, Bosch J, et al. Risk factors for failure in early prosthetic joint infection treated with debridement. Influence of etiology and antibiotic treatment. J Appl Biomater Funct Mater. 2014;12(3):129–34. https://doi.org/10.5301/jabfm.5000209.CrossRefPubMed

30.

Bedair HS, Katakam A, Bedeir YH, Yeroushalmi D, Schwarzkopf R. A decision analysis of treatment strategies for acute periprosthetic joint infection: early irrigation and debridement versus delayed treatment based on organism. J Orthop. 2020;22:246–50.CrossRef

Title: The role of fibrinogen in predicting reinfection after DAIR for periprosthetic joint infections
Authors: Dacheng Zhao
Jinwen He
Xingwen Wang
Xiaobing Zhao
Yayi Xia
Bin Geng
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Wound Debridement
Antibiotic
Joint Infection
Biomarkers
Published in: BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04357-8

At a glance: The STEP trials

Springer Medicine

The role of fibrinogen in predicting reinfection after DAIR for periprosthetic joint infections

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

A novel rat model of interbody fusion based on anterior lumbar corpectomy and fusion (ALCF)

Association of depressive symptoms and risk of knee pain: the moderating effect of sex

Evaluation of the standard procedure for treatment of periprosthetic joint infections of total knee and hip arthroplasty: a comparison of the 2015 and 2020 census in total joint replacement centres in Germany

Treatment of the fresh central slip avulsion of the extensor tendon by bone tunnel-tendon suture: a prospective cohort study

The “self” in pain: high levels of schema-enmeshment worsen fibromyalgia impact

Experimental study of the effects of hypoxia simulator on osteointegration of titanium prosthesis in osteoporotic rats