A Pilot Observational Study Evaluating the Diagnostic Capacity of Rotational Thromboelastometry in Periprosthetic Joint Infections

Author:

Tsantes Andreas G.12,Papadopoulos Dimitrios V.3,Goumenos Stavros4,Trikoupis Ioannis G.4,Tsante Konstantina A.5,Bellou Vanesa67,Koulouvaris Panagiotis4,Houhoula Dimitra1,Kriebardis Anastasios5,Piovani Daniele89,Nikolopoulos Georgios K.10,Mavrogenis Andreas F.4,Papagelopoulos Panayiotis J.4,Bonovas Stefanos89,Tsantes Argirios E.1

Affiliation:

1. Laboratory of Haematology and Blood Bank Unit, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

2. Microbiology Department, Saint Savvas Oncology Hospital, Athens, Greece

3. Second Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

4. First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

5. Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Sciences, School of Health & Caring Sciences, University of West Attica, Egaleo, Greece

6. Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece

7. Department of Respiratory Medicine, School of Medicine, University of Ioannina, Ioannina, Greece

8. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

9. IRCCS Humanitas Research Hospital, Milan, Italy

10. Laboratory of Medical Statistics, Epidemiology and Public Health, Medical School, University of Cyprus, Nicosia, Cyprus, Greece

Abstract

Background: Periprosthetic joint infections (PJIs) are associated with altered hemostatic dynamics; therefore, coagulation laboratory methods such as rotational thromboelastometry (ROTEM) may be valuable in their diagnosis. The aim of this study was to evaluate the diagnostic role of ROTEM in PJI. Methods: A diagnostic study was conducted including 65 patients who underwent revision total hip arthroplasty or total knee arthroplasty due to PJI (30 patients) or aseptic loosening (35 patients). Preoperative laboratory evaluation included conventional coagulation studies, inflammatory markers, and ROTEM analysis. These parameters were compared between patients with PJI and patients with aseptic loosening. Results: Several ROTEM parameters differed in the patients with PJI, indicating a higher coagulation potential associated with PJI. Specifically, the development of PJI was associated with higher EXTEM maximum clot firmness (MCF) (odds ratio [OR], 1.12 [95% confidence interval (CI), 1.04 to 1.20]; p = 0.001). Among the ROTEM parameters, EXTEM MCF was found to have the highest diagnostic accuracy for PJI (area under the receiver operating characteristic curve, 0.850; sensitivity, 76.6%; specificity, 91.4%), which was comparable with C-reactive protein (CRP) (p = 0.22) and erythrocyte sedimentation rate (ESR) (p = 0.65), but higher than D-dimer (p = 0.037). Moreover, the combined diagnostic accuracy of elevated EXTEM MCF and CRP was improved compared with CRP alone (p = 0.019). Conclusions: Our results indicate that ROTEM analysis might be helpful for the detection of the hemostatic derangements that are associated with the development of PJI. However, because of the small size of this pilot study, further research is needed to investigate the value of incorporating viscoelastic studies in diagnostic scores for PJI. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Orthopedics and Sports Medicine,General Medicine,Surgery

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