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. 2024 Dec 1;30(8):309-314.
doi: 10.1097/RHU.0000000000002157. Epub 2024 Oct 30.

Periprosthetic Joint Infection in Patients With Inflammatory Arthritis: Optimal Tests to Differentiate From Flares

Susan M Goodman  1 , Insa Mannstadt  1 , Kathleen Tam  2 , Bella Mehta, Alejandro Kochen  1 , Lorien Shakib  1 , Peter Sculco  2 , Alberto Carli  2 , Stephen Batter  1 , Jose Rodriguez  2 , Anne R Bass, Jason L Blevins  2 , Andy O Miller  1 , Linda Russell  1 , Laura Donlin  1 , Allina Nocon  2 , Mark Figgie  2
Affiliations

Periprosthetic Joint Infection in Patients With Inflammatory Arthritis: Optimal Tests to Differentiate From Flares

Susan M Goodman et al. J Clin Rheumatol. .

Abstract

Objective: Diagnosis of periprosthetic joint infection (PJI) in patients with inflammatory arthritis (IA) is challenging, as features of IA flares can mimic infection. We aimed to cross-sectionally determine if the optimal tests to diagnose PJI in osteoarthritis were present in patients with IA flares.

Methods: We enrolled patients from October 2020 to July 2022 in 3 groups: ( a ) PJI-total joint arthroplasty patients undergoing revision for infection, ( b ) IA Flare-IA patients with a flaring native joint, and ( c ) IA Aseptic-total joint arthroplasty patients with IA undergoing aseptic arthroplasty revision. We compared blood and synovial fluid markers between the cohorts using Kruskal-Wallis and Fisher exact tests to assess marker sensitivity and specificity.

Results: Of 52 cases overall, 40% had rheumatoid arthritis, 20% psoriatic arthritis, and 11% osteoarthritis (in PJI group). PJI cases had higher C-reactive protein (CRP) and synovial fluid polymorphonuclear neutrophil percentage (%PMN). Alpha-defensin tested positive in 93% of PJI cases, 20% of IA Flares, and 6% of IA Aseptic ( p < 0.01). Synovial white blood cell count >3000/μL and positive alpha-defensin were highly sensitive (100%) in diagnosing infection; however, specificity was 50% for white blood cell counts and 79% for alpha-defensin. PJI diagnosis was nearly 5 times more likely with positive alpha-defensin and almost 6 times more likely with %PMNs >80. Blood markers interleukin-6, procalcitonin, and d -dimer were neither sensitive nor specific, whereas erythrocyte sedimentation rate and CRP showed 80% sensitivity, but 47% and 58% respective specificities.

Conclusions: Although synovial %PMNs, CRP, and alpha-defensin are sensitive tests for diagnosing PJI, they are less specific and may be positive in IA flares.

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Conflict of interest statement

COMPETING INTERESTS: Susan M. Goodman reports consultancy for UCB, research support from Novartis, and ownership interest in Regenosine Inc.

Peter Sculco reports consultancy and research support from Intellijoint Surgical and Zimmer Biomet, and consultancy for DePuy Synthes, EOS Imaging, and Lima Corporate.

Mark Figgie reports ownership interest in HS2 and Joint Effort ASO, consultancy and royalties in Lima Corporate, and Ownership interest, IP/patents, board membership, consultancy, and royalties in Wishbone Medical.

Laura Donlin reports consultancy of Bristol-Myers Squibb and Stryker.

Bella Mehta reports consultancy for Janssen and Novartis.

Jason L Blevins reports consultancy for Globus Medical, KCI, and Lima Corporate.

Anne Bass reports board membership in the American College of Rheumatology.

Jose Rodriguez reports royalties and consultancy from Exactech, Medacta, Conformis, and Smith and Nephew. He also reports research support from Exactech, Medacta, and Smith and Nephew. He reports stock options in Wishbone Medical. He reports board membership in the Journal of Arthroplasty, Clinical Orthopedics and Related Research, and the Bone and Joint Journal.

The remaining authors declare no competing financial interests.

Figures

Figure 1:
Figure 1:
STROBE flow chart of patient recruitment
See this image and copyright information in PMC

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