What Markers Best Guide the Timing of Reimplantation in Two-stage Exchange Arthroplasty for PJI? A Systematic Review and Meta-analysis

Clinical Orthopaedics and Related Research
Yong Seuk LeeAntonia F Chen

Abstract

There is no consensus on the appropriate marker to use when deciding to perform reimplantation after two-stage exchange arthroplasty for periprosthetic joint infection (PJI). What tests provide acceptable diagnostic value to guide appropriate timing of reimplantation in two-stage exchange arthroplasty for PJI? A search of online databases (MEDLINE, EMBASE, OVID, and Cochrane database) was performed containing articles that provided sensitivity and specificity values for accuracy for predicting reimplantation of the hip and/or knee. Twelve articles were included for final analysis, which included data from 1047 patients. Data that described the diagnostic accuracy of markers for reimplantation were evaluated and categorized into four main entities according to diagnostic method (serologic, synovial, tissue, and diagnostic imaging). Twelve parameters were examined, including serum erythrocyte sedimentation (ESR) rate, serum C-reactive protein (CRP), serum white blood cell (WBC) count, synovial fluid Gram stain, synovial fluid culture, synovial fluid sonication culture, synovial fluid WBC, synovial fluid polymorphonucleocyte percentage (PMN%), tissue Gram stain, tissue culture, positron emission tomography scan, and leukocyte scan...Continue Reading

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Citations

Jul 12, 2020·Journal of Orthopaedic Surgery and Research·Cheng LiAndrej Trampuz
Mar 3, 2021·The Journal of Arthroplasty·Christopher N CarenderNicholas A Bedard
Feb 21, 2021·The Journal of Arthroplasty·Bernhard J H FrankJochen G Hofstaetter
Oct 3, 2021·The Journal of Knee Surgery·Blair S Ashley, Javad Parvizi

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