A Pilot Observational Study Evaluating the Diagnostic Capacity of Rotational Thromboelastometry in Periprosthetic Joint Infections
Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated..
BACKGROUND: Periprosthetic joint infections (PJIs) are associated with altered hemostatic dynamics; therefore, coagulation laboratory methods such as rotational thromboelastometry (ROTEM) may be valuable in their diagnosis. The aim of this study was to evaluate the diagnostic role of ROTEM in PJI.
METHODS: A diagnostic study was conducted including 65 patients who underwent revision total hip arthroplasty or total knee arthroplasty due to PJI (30 patients) or aseptic loosening (35 patients). Preoperative laboratory evaluation included conventional coagulation studies, inflammatory markers, and ROTEM analysis. These parameters were compared between patients with PJI and patients with aseptic loosening.
RESULTS: Several ROTEM parameters differed in the patients with PJI, indicating a higher coagulation potential associated with PJI. Specifically, the development of PJI was associated with higher EXTEM maximum clot firmness (MCF) (odds ratio [OR], 1.12 [95% confidence interval (CI), 1.04 to 1.20]; p = 0.001). Among the ROTEM parameters, EXTEM MCF was found to have the highest diagnostic accuracy for PJI (area under the receiver operating characteristic curve, 0.850; sensitivity, 76.6%; specificity, 91.4%), which was comparable with C-reactive protein (CRP) (p = 0.22) and erythrocyte sedimentation rate (ESR) (p = 0.65), but higher than D-dimer (p = 0.037). Moreover, the combined diagnostic accuracy of elevated EXTEM MCF and CRP was improved compared with CRP alone (p = 0.019).
CONCLUSIONS: Our results indicate that ROTEM analysis might be helpful for the detection of the hemostatic derangements that are associated with the development of PJI. However, because of the small size of this pilot study, further research is needed to investigate the value of incorporating viscoelastic studies in diagnostic scores for PJI.
LEVEL OF EVIDENCE: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
| Errataetall: |
CommentIn: J Bone Joint Surg Am. 2023 Dec 20;105(24):e58. - PMID 38117269 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:105 |
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| Enthalten in: |
The Journal of bone and joint surgery. American volume - 105(2023), 24 vom: 20. Dez., Seite 1980-1986 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tsantes, Andreas G [VerfasserIn] |
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| Links: |
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| Themen: |
9007-41-4 |
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| Anmerkungen: |
Date Completed 21.12.2023 Date Revised 22.02.2024 published: Print-Electronic CommentIn: J Bone Joint Surg Am. 2023 Dec 20;105(24):e58. - PMID 38117269 Citation Status MEDLINE |
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| doi: |
10.2106/JBJS.23.00532 |
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| Förderinstitution / Projekttitel: |
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NLM363952772 |
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| 100 | 1 | |a Tsantes, Andreas G |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A Pilot Observational Study Evaluating the Diagnostic Capacity of Rotational Thromboelastometry in Periprosthetic Joint Infections |
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| 500 | |a Date Completed 21.12.2023 | ||
| 500 | |a Date Revised 22.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Bone Joint Surg Am. 2023 Dec 20;105(24):e58. - PMID 38117269 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated. | ||
| 520 | |a BACKGROUND: Periprosthetic joint infections (PJIs) are associated with altered hemostatic dynamics; therefore, coagulation laboratory methods such as rotational thromboelastometry (ROTEM) may be valuable in their diagnosis. The aim of this study was to evaluate the diagnostic role of ROTEM in PJI | ||
| 520 | |a METHODS: A diagnostic study was conducted including 65 patients who underwent revision total hip arthroplasty or total knee arthroplasty due to PJI (30 patients) or aseptic loosening (35 patients). Preoperative laboratory evaluation included conventional coagulation studies, inflammatory markers, and ROTEM analysis. These parameters were compared between patients with PJI and patients with aseptic loosening | ||
| 520 | |a RESULTS: Several ROTEM parameters differed in the patients with PJI, indicating a higher coagulation potential associated with PJI. Specifically, the development of PJI was associated with higher EXTEM maximum clot firmness (MCF) (odds ratio [OR], 1.12 [95% confidence interval (CI), 1.04 to 1.20]; p = 0.001). Among the ROTEM parameters, EXTEM MCF was found to have the highest diagnostic accuracy for PJI (area under the receiver operating characteristic curve, 0.850; sensitivity, 76.6%; specificity, 91.4%), which was comparable with C-reactive protein (CRP) (p = 0.22) and erythrocyte sedimentation rate (ESR) (p = 0.65), but higher than D-dimer (p = 0.037). Moreover, the combined diagnostic accuracy of elevated EXTEM MCF and CRP was improved compared with CRP alone (p = 0.019) | ||
| 520 | |a CONCLUSIONS: Our results indicate that ROTEM analysis might be helpful for the detection of the hemostatic derangements that are associated with the development of PJI. However, because of the small size of this pilot study, further research is needed to investigate the value of incorporating viscoelastic studies in diagnostic scores for PJI | ||
| 520 | |a LEVEL OF EVIDENCE: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
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| 650 | 7 | |a Hemostatics |2 NLM | |
| 650 | 7 | |a Biomarkers |2 NLM | |
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| 700 | 1 | |a Goumenos, Stavros |e verfasserin |4 aut | |
| 700 | 1 | |a Trikoupis, Ioannis G |e verfasserin |4 aut | |
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| 700 | 1 | |a Piovani, Daniele |e verfasserin |4 aut | |
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| 700 | 1 | |a Bonovas, Stefanos |e verfasserin |4 aut | |
| 700 | 1 | |a Tsantes, Argirios E |e verfasserin |4 aut | |
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