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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(06): e917-e923
DOI: 10.1055/s-0043-1776907
Artigo Original | Original Article

Acurácia dos marcadores sorológicos, do líquido sinovial, da cultura microbiológica e do exame histopatológico para o diagnóstico de infecção periprotética do joelho

Article in several languages: português | English
Alan de Paula Mozella 
1   Médico ortopedista e traumatologista do Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Hugo Alexandre de Araújo Barros Cobra 
1   Médico ortopedista e traumatologista do Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Sandra Tie Nishibe Minamoto 
1   Médico ortopedista e traumatologista do Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
,
Rodrigo Salim 
2   Médico ortopedista e traumatologista do Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP-RP), Ribeirão Preto, São Paulo, Brasil
,
Ana Carolina Leal 
3   Pesquisadora da Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
› Author Affiliations Suporte Financeiro Não houve suporte financeiro de fontes públicas, comerciais, ou sem fins lucrativos.
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Resumo

Objetivo avaliar a sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia dos testes sorológicos, dos marcadores do líquido sinovial, da cultura microbiológica de tecidos e do exame histopatológico da membrana periprotética para o diagnóstico de infecção periprotética do joelho.

Métodos: estudo prospectivo, com pacientes submetidos à cirurgia de revisão de artroplastia total do joelho no período entre novembro de 2019 e dezembro de 2021. Foi realizado análise do marcadores sorológicos (VHS,PCR e D-dímero), do líquido sinovial (contagem de leucócitos e percentual de polimorfonucleares), cultura de tecidos periprotéticos e exame histopatológico da membrana periprotética de todos os pacientes.

Resultados 62 pacientes foram diagnosticados com infecção periprotética do joelho, pelos critérios do International Consensus Meeting 2018 (grupo infecção) e 22 pacientes integraram o grupo não infecção. A sensibilidade e especificidade da VHS foram de 83,6% e 45,4%, respectivamente. Os valores de sensibilidade e especificidade da PCR foram de 64,5% e 100% e as do D-dímero foram de 78,9%% e 25%, respectivamente. A sensibilidade e especificidade da contagem de leucócitos foi de 75,6% e 100%, e a do percentual de polimorfonucleares foi de 33% e 100%, respectivamente. A sensibilidade e especificidade das culturas de tecidos periprotéticos foi de, respectivamente, 77,4% e 100% A sensibilidade do exame histopatológico foi de 43,7% e a especificidade de 100%.

Conclusões A contagem total de leucócitos no líquido sinovial e as culturas microbiológicas dos tecidos periprotéticos foram os testes de maior acurácia para o diagnóstico de infecção periprotética em nossa série. O percentual de polimorfonucleares foi o teste de menor acurácia, em nosso estudo, para o diagnóstico de infecção periprotética.

Palavras-chave

artroplastia do joelho - complicações pós-operatórias - infecção periprotética - biomarcadores

Estudo desenvolvido no Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil




Publication History

Received: 29 August 2022

Accepted: 18 January 2023

Article published online:
08 December 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Fuchs M, Trampuz A, Kirschbaum S, Winkler T, Sass FA. Soluble Pecam-1 as a Biomarker in Periprosthetic Joint Infection. J Clin Med 2021; 10 (04) 612
    CrossrefPubMedGoogle Scholar
  • 2 McNally M, Sousa R, Wouthuyzen-Bakker M. et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J 2021; 103-B (01) 18-25
    CrossrefPubMedGoogle Scholar
  • 3 Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev 2019; 4 (07) 482-494
    CrossrefPubMedGoogle Scholar
  • 4 Li C, Renz N, Trampuz A, Ojeda-Thies C. Twenty common errors in the diagnosis and treatment of periprosthetic joint infection. Int Orthop 2020; 44 (01) 3-14
    CrossrefPubMedGoogle Scholar
  • 5 Parvizi J, Tan TL, Goswami K. et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty 2018; 33 (05) 1309-1314.e2
    CrossrefPubMedGoogle Scholar
  • 6 Villa JM, Pannu TS, Piuzzi N, Riesgo AM, Higuera CA. Evolution of Diagnostic Definitions for Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty. J Arthroplasty 2020; 35 (3S): S9-S13
    CrossrefPubMedGoogle Scholar
  • 7 Schwarz EM, Parvizi J, Gehrke T. et al. 2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions. J Orthop Res 2019; 37 (05) 997-1006
    CrossrefPubMedGoogle Scholar
  • 8 Yan CH, Arciola CR, Soriano A, Levin LS, Bauer TW, Parvizi J. Team Approach: The Management of Infection After Total Knee Replacement. JBJS Rev 2018; 6 (04) e9
    CrossrefPubMedGoogle Scholar
  • 9 Wasterlain AS, Goswami K, Ghasemi SA, Parvizi J. Diagnosis of Periprosthetic Infection: Recent Developments. J Bone Joint Surg Am 2020; 102 (15) 1366-1375
    CrossrefPubMedGoogle Scholar
  • 10 Carli AV, Abdelbary H, Ahmadzai N. et al. Diagnostic Accuracy of Serum, Synovial, and Tissue Testing for Chronic Periprosthetic Joint Infection After Hip and Knee Replacements: A Systematic Review. J Bone Joint Surg Am 2019; 101 (07) 635-649
    CrossrefPubMedGoogle Scholar
  • 11 Iorio R, Viglietta E, Mazza D. et al. Accuracy and Cost-Effectivenss of a Novel Method for Alpha Defensins Measurement in the Diagnosis of Periprosthetic Joint Infections. J Arthroplasty 2021; 36 (09) 3275-3281
    CrossrefPubMedGoogle Scholar
  • 12 Tubb CC, Polkowksi GG, Krause B. Diagnosis and Prevention of Periprosthetic Joint Infections. J Am Acad Orthop Surg 2020; 28 (08) e340-e348
    CrossrefPubMedGoogle Scholar
  • 13 Sharma K, Ivy M, Block DR. et al. Comparative analysis of 23 synovial fluid biomarkers for hip and knee periprosthetic joint infection detection. J Orthop Res 2020; 38 (12) 2664-2674
    CrossrefPubMedGoogle Scholar
  • 14 Kheir MM, Tan TL, Shohat N, Foltz C, Parvizi J. Routine Diagnostic Tests for Periprosthetic Joint Infection Demonstrate a High False-Negative Rate and Are Influenced by the Infecting Organism. J Bone Joint Surg Am 2018; 100 (23) 2057-2065
    CrossrefPubMedGoogle Scholar
  • 15 Uvodich ME, Dugdale EM, Osmon DR, Pagnano MW, Berry DJ, Abdel MP. The effectiveness of laboratory tests to predict early postoperative periprosthetic infection after total knee arthroplasty. Bone Joint J 2021; 103-B (6, Supple A) 177-184
    CrossrefPubMedGoogle Scholar
  • 16 Pérez-Prieto D, Portillo ME, Puig-Verdié L. et al. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop 2017; 41 (07) 1315-1319
    CrossrefPubMedGoogle Scholar
  • 17 Palan J, Nolan C, Sarantos K, Westerman R, King R, Foguet P. Culture-negative periprosthetic joint infections. EFORT Open Rev 2019; 4 (10) 585-594
    CrossrefPubMedGoogle Scholar
  • 18 Shahi A, Kheir MM, Tarabichi M, Hosseinzadeh HRS, Tan TL, Parvizi J. Serum D-Dimer Test Is Promising for the Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation. J Bone Joint Surg Am 2017; 99 (17) 1419-1427
    CrossrefPubMedGoogle Scholar
  • 19 Li R, Shao HY, Hao LB. et al. Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection: A Multicenter Retrospective Study. J Bone Joint Surg Am 2019; 101 (07) 613-619
    CrossrefPubMedGoogle Scholar
  • 20 Pan L, Wu H, Liu H, Yang X, Meng Z, Cao Y. Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials. J Orthop Surg Res 2021; 16 (01) 30
    CrossrefPubMedGoogle Scholar
  • 21 Xu H, Xie J, Huang Q, Lei Y, Zhang S, Pei F. Plasma Fibrin Degradation Product and D-Dimer Are of Limited Value for Diagnosing Periprosthetic Joint Infection. J Arthroplasty 2019; 34 (10) 2454-2460
    CrossrefPubMedGoogle Scholar
  • 22 Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2016; 387 (10016): 386-394
    CrossrefPubMedGoogle Scholar
  • 23 Chisari E, Parvizi J. Accuracy of blood-tests and synovial fluid-tests in the diagnosis of periprosthetic joint infections. Expert Rev Anti Infect Ther 2020; 18 (11) 1135-1142
    CrossrefPubMedGoogle Scholar
  • 24 Balato G, Franceschini V, Ascione T, Lamberti A, Balboni F, Baldini A. Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections. Arch Orthop Trauma Surg 2018; 138 (02) 165-171
    CrossrefPubMedGoogle Scholar
  • 25 Filep JG, Ariel A. Neutrophil heterogeneity and fate in inflamed tissues: implications for the resolution of inflammation. Am J Physiol Cell Physiol 2020; 319 (03) C510-C532
    CrossrefPubMedGoogle Scholar
  • 26 Deniset JF, Kubes P. Neutrophil heterogeneity: Bona fide subsets or polarization states?. J Leukoc Biol 2018; 103 (05) 829-838
    CrossrefPubMedGoogle Scholar
  • 27 Muñoz-Mahamud E, Molinas I, Lozano L. et al. Usefulness of Culturing the Periprosthetic Membrane or Neosynovium for the Diagnosis of Infection During Hip and Knee Revision Arthroplasty. J Am Acad Orthop Surg 2018; 26 (20) e442-e447
    CrossrefPubMedGoogle Scholar