Highlights
- •Synovial fluid C-reactive protein has a high negative predictive value of 98%.
- •In periprosthetic joint infections it is significant elevated.
- •There is no additional advantage to the established MSIS criteria.
Abstract
Objectives
Synovial fluid C-reactive protein (syCRP) has been recently described as a new biomarker
in preoperative diagnostics to identify periprosthetic joint infections (PJI). The
aim of this study was to evaluate syCRP in a large cohort of patients with suspected
PJI and to calculate the optimal cut-off to diagnose PJI.
Methods
Between September 2015 and June 2017, we prospectively included patients with suspected
PJI, in which syCRP was additionally measured along with routine preoperative diagnostic
serum and synovial biomarkers. We analysed the sensitivity and specificity of syCRP
using receiver operating characteristic curves.
Results
We included 192 cases (hip n = 80, knee n = 91, shoulder n = 21) with a final diagnosis of PJI in 26 cases (14.0%). Combined for all joints,
the syCRP values were significantly higher in the PJI group than in the no PJI group
(median: 13.8 vs. 0 mg/l; p < 0.001). The optimal cut-off (Youden Index: 0.71) for the PJI diagnosis combined
for all joints was at a syCRP value of 2.9 mg/l with a sensitivity of 88%, a specificity
of 82%, and a negative predictive value of 98%.
Conclusions
SyCRP features high negative predictive value but is not useful as a single diagnostic
parameter in suspected periprosthetic joint infection (PJI).
Keywords
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Article info
Publication history
Published online: April 16, 2019
Accepted:
April 1,
2019
Identification
Copyright
© 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
