Abstract:
BACKGROUND:Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing periprosthetic joint infection (PJI). QUESTIONS/PURPOSES:We aimed to (1) determine if there is a correlation between serum and synovial CRP values, (2) establish cutoff values for diagnosing infection based on serum and synovial CRP, and (3) compare the utility of measuring CRP in synovial fluid versus serum for the diagnosis of PJI using standard assay equipment available at most hospitals. METHODS:Between February 2011 and March 2012, we invited all 150 patients scheduled for revision TKA (84) or THA (66) to participate in this prospective study, of whom 100% agreed. Data ultimately were missing for 31 patients, leaving 60 patients undergoing revision TKA and 59 undergoing revision THA (71% and 89% of the original group, respectively) for whom CRP level was measured in serum and synovial fluid samples. Patients were deemed to have a PJI (32) or no infection (87) using Musculoskeletal Infection Society criteria. Serum and synovial CRP levels were assayed using the same immunospectrophotometer and the correlation coefficient was calculated. Receiver operating characteristic curve analyses were performed to compare utility in diagnosing PJI, which included area under the curve, diagnostic threshold, and test sensitivity, specificity, predictive values, and accuracy. In 22 of 150 patients (14.7%), synovial CRP could not be measured because the sample was too viscous or hemolyzed. RESULTS:In the analyzed 119 samples, there was a strong correlation (r = 0.76; p < 0.001) between synovial and serum CRP. The area under the curve was 0.90 both for the synovial fluid (95% CI, 0.82-0.97) and serum (95% CI, 0.84-0.96) CRP assays. The diagnostic thresholds were 6.6 mg/L for synovial fluid and 11.2 mg/L for serum. Sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were similar for synovial fluid and serum assays. CONCLUSIONS:Although recent studies have suggested a superiority of synovial fluid CRP over serum CRP for the diagnosis of PJI, we found that measurement of CRP in synovial fluid rather than serum using readily available assay equipment does not offer a diagnostic advantage in detection of PJIs. LEVEL OF EVIDENCE:Level II, diagnostic study. See the Instructions to Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Tetreault MW,Wetters NG,Moric M,Gross CE,Della Valle CJdoi
10.1007/s11999-014-3828-ysubject
Has Abstractpub_date
2014-12-01 00:00:00pages
3997-4003issue
12eissn
0009-921Xissn
1528-1132journal_volume
472pub_type
杂志文章abstract::The Knee Society Total Knee Arthroplasty Radiographic Evaluation and Scoring System was introduced to encourage uniform reporting of radiographic outcome. However, the method for evaluation of radiolucent lines has been shown to be unreliable. Because it has been shown that reducing the complexity of classification sy...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000153077.79573.a4
更新日期:2005-05-01 00:00:00
abstract::The authors introduce a new functional classification of rheumatoid arthritis of the wrist. Unlike the classifications used today, it includes the aspect of the natural course of rheumatoid arthritis. The goal of this paper is to identify radiologic indicators that will classify rheumatoid arthritis into stable forms ...
journal_title:Clinical orthopaedics and related research
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doi:
更新日期:1999-09-01 00:00:00
abstract::With the use of a stereoscopic microscope, observations were made on the course of the proper digital nerve of the thumb on ten upper limbs in adult cadavers. By observation from the dorsal side after removal of the bone, it was possible to clearly see the ramification of the digital nerve from the subcutaneous tissue...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-09-01 00:00:00
abstract::The introduction of alumina ceramic combined with the self-locking principle by surface increase has many followers. There is no manufacturing company in the world that does not produce self-locking hip prostheses with ceramic components. Despite increased interim results with conventional prostheses by improved cemen...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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abstract::Saos-2 cultured human osteosarcoma cells contain an extractable bone inducing agent that can induce heterotopic bone in the muscle of Nu/Nu mice. A semipurified GuHCl extract of Saos-2 cells also can promote healing and complete bony union in otherwise non-healing surgically induced defects of rat femur. Northern blot...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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更新日期:1980-03-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2003-09-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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更新日期:1977-03-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1990-05-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1994-11-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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doi:
更新日期:1994-01-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-03-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-09-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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pub_type: 杂志文章
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更新日期:1988-09-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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更新日期:1976-06-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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更新日期:1988-04-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:2008-01-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:2000-05-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1982-06-01 00:00:00