Clinical Orthopaedics and Related Research: August 2013 - Volume 471 - Issue 8 - p 2621–2628 doi: 10.1007/s11999-013-2998-3 Clinical Research

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Glehr, Mathias, MD1, a; Friesenbichler, Joerg, MD1; Hofmann, Günter, MD2; Bernhardt, Gerwin, Alexander, MD3; Zacherl, Maximilian, MD1; Avian, Alexander, PhD4; Windhager, Reinhard, MD5; Leithner, Andreas, MD1
Hip Knee

Background A periprosthetic joint infection is one of the most challenging complications associated with THA and TKA. In the diagnostic process for detecting a periprosthetic joint infection, one of the most important steps is analysis of laboratory infection biomarkers.


Questions/purposes We investigated the sensitivity and specificity of the biomarkers procalcitonin, interleukin 6 (IL-6), and interferon α (IFN-α) as compared with conventional biomarkers (C-reactive protein [CRP], leukocyte level) for a periprosthetic joint infection associated with revision arthroplasties.


Methods We prospectively included and analyzed 84 patients (124 revision arthroplasties). The blood parameters of interest were procalcitonin, IL-6, IFN-α, leukocyte level, and CRP. Samples were taken preoperatively and on the first, third, and seventh postoperative days. The sensitivity and specificity of these biomarkers then were calculated.


Results Considering the preoperative values of 84 patients (124 operations), procalcitonin, IL-6, CRP, and leukocyte level correlated with periprosthetic joint infection, whereas IFN-α did not. A procalcitonin cut-off level of 0.35 ng/mL revealed a sensitivity of 80% and specificity of 37%. An IL-6 cut-off level of 2.55 pg/mL had a sensitivity of 92% and specificity of 59%.


Conclusions In this study procalcitonin and IL-6 were helpful for detecting periprosthetic joint infections in revision arthroplasties, although CRP generally was superior. Procalcitonin and IL-6 may be considered adjuvant tests when the diagnosis of a periprosthetic joint infection is in doubt. This study showed, in addition to conventional biomarkers such as CRP and leukocyte level, procalcitonin and IL-6 were helpful for detecting infections associated with revision arthroplasties.


Level of Evidence Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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