Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 13;22(1):689.
doi: 10.1186/s12891-021-04578-x.

Thromboelastography parameters in diagnosing periprosthetic joint infection and predicting reimplantation timing

Tao Yuan  1 , Yi Wang  1 , Shui Sun  2   3
Affiliations

Thromboelastography parameters in diagnosing periprosthetic joint infection and predicting reimplantation timing

Tao Yuan et al. BMC Musculoskelet Disord. .

Abstract

Background: Coagulation-related biomarkers are drawing new attention in the diagnosis of periprosthetic joint infection (PJI). The thromboelastography (TEG) assay provides a comprehensive assessment of blood coagulation; therefore, it could be a promising test for PJI. This study aims to assess the value of TEG in diagnosing PJI and to determine the clinical significance of TEG in analysing reimplantation timing for second-stage revision.

Methods: From October 2017 to September 2020, 62 patients who underwent revision arthroplasty were prospectively included. PJI was defined by the 2011 Musculoskeletal Infection Society criteria, in which 23 patients were diagnosed with PJI (Group A), and the remaining 39 patients were included as having aseptic loosening (Group B). In group A, 17 patients completed a two-stage revision in our centre. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, and TEG parameters (clotting time, α-angle, MA [maximum amplitude], amplitude at 30 min, and thrombodynamic potential index) were measured preoperatively in all included patients. In addition, receiver operating characteristic curves were used to evaluate the diagnostic value of these biomarkers.

Results: ESR (area under curve [AUC], 0.953; sensitivity, 81.82; specificity, 94.87) performed best for PJI diagnosis, followed by MA (AUC, 0.895; sensitivity, 82.61; specificity, 97.44) and CRP (AUC, 0.893; sensitivity, 82.61; specificity, 94.74). When these biomarkers were combined in pairs, the diagnostic value improved compared with any individual biomarker. The overall success rate of the two-stage revision was 100%. Furthermore, ESR and MA were valuable in determining the time of reimplantation, and their values all decreased below the cut-off values before reimplantation.

Conclusion: TEG could be a promising test in assisting PJI diagnosis, and a useful tool in judging the proper timing of reimplantation.

Keywords: Coagulation-related biomarkers; Periprosthetic joint infection; Thromboelastography; Two-stage revision.

PubMed Disclaimer

Conflict of interest statement

The authors declare they have no financial interests.

Figures

Fig. 1
Fig. 1
The comparison of ROC curves. ROC, receiver operating characteristic curve. CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; MA, maximum amplitude; K, clotting time; Angle, α-angle; A30, amplitude at 30 min; TPI, thrombodynamic potential index
Fig. 2
Fig. 2
The distributions of D-dimer (a), ESR (b), CRP (c), K (d), Angle (e), MA (f), A30 (g), and TPI (h) levels before and after the first staged revision surgery. Stage 1: Stage before spacer insertion. Stage 2: Stage after re-admission for the second stage. Dotted lines represent the optimal cutoff values based on the present study. ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; K, clotting time; Angle, α-angle; MA, maximum amplitude; A30, amplitude at 30 min; TPI, thrombodynamic potential index
See this image and copyright information in PMC

References

    1. Berns E, Barrett C, Gardezi M, Spake C, Glasser J, Antoci V, Born CT, Garcia DR. Current clinical methods for detection of peri-prosthetic joint infection. Surg Infect. 2020;21(8):645–653. doi: 10.1089/sur.2019.314. - DOI - PMC - PubMed
    1. Pannu TS, Villa JM, Patel PD, Riesgo AM, Barsoum WK, Higuera CA. The utility of serum D-dimerfor the diagnosis of periprosthetic joint infection in revision total hip and knee arthroplasty. J Arthroplast. 2020;35(6):1692–1695. doi: 10.1016/j.arth.2020.01.034. - DOI - PubMed
    1. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302–345. doi: 10.1128/cmr.00111-13. - DOI - PMC - PubMed
    1. Xiong L, Li S, Dai M. Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection. J Orthop Surg Res. 2019;14(1):240. doi: 10.1186/s13018-019-1282-y. - DOI - PMC - PubMed
    1. Hu Q, Fu Y, Tang L. Serum D-dimeras a diagnostic index of PJI and retrospective analysis of etiology in patients with PJI. Clin Chim Acta. 2020;506:67–71. doi: 10.1016/j.cca.2020.03.023. - DOI - PubMed