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Continuous monitoring of serum markers for early detection of periprosthetic joint infection in osteoporotic patients undergoing hip arthroplasty: A prospective cohort study

Year: 2025

Type: article

Abstract: Background: Periprosthetic joint infection (PJI) is a significant complication following hip arthroplasty, especially in osteoporotic patients. Early detection is crucial for improving outcomes but remains challenging. This study assesses the effectiveness of continuous monitoring of serum markers - C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), D-dimer, white blood cell count (WBC), ferritin, soluble CD14 (sCD14), matrix metalloproteinase-9 (MMP-9), and serum amyloid A (SAA) - for early detection of PJI in osteoporotic patients undergoing hip arthroplasty. Methods: A prospective cohort study included 150 osteoporotic patients undergoing hip arthroplasty. Inflammatory markers were measured preoperatively and at 24-, 48-, and 72 hours post-surgery, with weekly follow-ups for 6 weeks. PJI was diagnosed based on clinical, microbiological, and imaging criteria. The diagnostic performance of individual markers was assessed using Receiver Operating Characteristic (ROC) curves. Results: Among the 150 patients, 12 (8%) developed PJI within 6 weeks. At 48 hours post-surgery, CRP PCT, ESR, D-dimer, WBC, sCD14, and SAA were significantly higher in the PJI group compared to the non-infected group (p< 0.05 for all). Ferritin and MMP-9 levels showed higher values in the infected group but did not reach statistical significance (p= 0.076 and p= 0.094, respectively). The combination of CRP D-dimer, WBC, sCD14, and SAA demonstrated 90% sensitivity and 92% specificity for PJI detection. Conclusions: Continuous monitoring of CRP, D-dimer, WBC, sCD14, and SAA offers a reliable approach for early detection of PJI in osteoporotic patients undergoing hip arthroplasty. These markers showed strong associations with infection, while ferritin and MMP-9 were less informative. This strategy may help improve early diagnosis and patient outcomes.

Source: Journal of Medical Biochemistry

DOI: 10.5937/jomb0-57013

Authors: Panfeng Wang, Dayuan Xu, Yan Xia, Yuntong Zhang, Yongming Sun

Institutions: Second Affiliated Hospital of Soochow University, Second Military Medical University, Changhai Hospital

Language: English

Topic: Orthopedic Infections and Treatments

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funders: Soochow University, Changhai Hospital of Shanghai, Second Affiliated Hospital of Soochow University