This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research article
Shui Sun
Shandong University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9744-1595
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Coagulation-related biomarkers are drawing new attention in diagnosing periprosthetic joint infection (PJI). Thromboelastography (TEG) analysis provides a comprehensive assessment of coagulation and therefore 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 analyzing reimplantation timing for the second-stage revision.
Methods: From October 2017 to September 2020, 62 patients who underwent revision arthroplasty were prospectively included, PJI was defined by 2011 Musculoskeletal Infection Society (MSIS) criteria. Twenty-three patients were diagnosed with PJI (Group A) and the other 39 patients were included as aseptic loosen (Group B). Seventeen patients in Group A finished two-stage revision in our center. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer and TEG parameters (K (clotting time), Angle (α-angle), MA (maximum amplitude), A30 (amplitude at 30 min), TPI (thrombodynamic potential index)) were measured preoperatively in all included patients. Receiver operating characteristic curves were applied to evaluate the diagnostic value of these biomarkers.
Results: ESR (AUC 0.953, sensitivity 81.82, specificity 94.87) performed best in 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 combined in pairs, the diagnosis value improved compared with any individual biomarker. The overall success rate of the two-stage revision was 100%. ESR and MA showed valuable in determining the time of reimplantation, with their values all decreased below 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
thromboelastography, periprosthetic joint infection, coagulation-related biomarkers, two-stage revision
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CURRENT STATUS: Under Review
Version 1
Posted 23 Feb, 2021
No community comments so far
Reviewer #3 agreed
On 16 May, 2021
Review #2 received
Received 15 May, 2021
Reviewer #2 agreed
On 03 May, 2021
Review #1 received
Received 12 Mar, 2021
Reviewer #1 agreed
On 08 Mar, 2021
Reviewers invited
Invitations sent on 24 Feb, 2021
Editor assigned
On 16 Feb, 2021
Submission checks complete
On 16 Feb, 2021
Editor invited
On 16 Feb, 2021
First submitted
On 19 Jan, 2021
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Subject Areas
Orthopedics
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Shui Sun
Shandong University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9744-1595
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 23 Feb, 2021
No community comments so far
Reviewer #3 agreed
On 16 May, 2021
Review #2 received
Received 15 May, 2021
Reviewer #2 agreed
On 03 May, 2021
Review #1 received
Received 12 Mar, 2021
Reviewer #1 agreed
On 08 Mar, 2021
Reviewers invited
Invitations sent on 24 Feb, 2021
Editor assigned
On 16 Feb, 2021
Submission checks complete
On 16 Feb, 2021
Editor invited
On 16 Feb, 2021
First submitted
On 19 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Coagulation-related biomarkers are drawing new attention in diagnosing periprosthetic joint infection (PJI). Thromboelastography (TEG) analysis provides a comprehensive assessment of coagulation and therefore 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 analyzing reimplantation timing for the second-stage revision.
Methods: From October 2017 to September 2020, 62 patients who underwent revision arthroplasty were prospectively included, PJI was defined by 2011 Musculoskeletal Infection Society (MSIS) criteria. Twenty-three patients were diagnosed with PJI (Group A) and the other 39 patients were included as aseptic loosen (Group B). Seventeen patients in Group A finished two-stage revision in our center. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer and TEG parameters (K (clotting time), Angle (α-angle), MA (maximum amplitude), A30 (amplitude at 30 min), TPI (thrombodynamic potential index)) were measured preoperatively in all included patients. Receiver operating characteristic curves were applied to evaluate the diagnostic value of these biomarkers.
Results: ESR (AUC 0.953, sensitivity 81.82, specificity 94.87) performed best in 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 combined in pairs, the diagnosis value improved compared with any individual biomarker. The overall success rate of the two-stage revision was 100%. ESR and MA showed valuable in determining the time of reimplantation, with their values all decreased below 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.
Figure 1
Figure 2
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