Clinical Significance Of Preoperative Peripheral Blood Coagulation Examination In Diagnosis Of Periprosthetic Joint Infection

ObjectivesTo explore the clinical significance of preoperative peripheral blood coagulation examination in the diagnosis of periprosthetic joint infection and to find new diagnostic indicators,we retrospectively collected cases who decided to take hip or knee revision surgery for various reasons in Shandong Provincial Hospital from July 2016 to December 2019,and collected the preoperative peripheral blood coagulation test data before surgery.We hope the results can provide reference for orthopaedist.Materials and MethodsA total of 84 patients undergoing hip and knee revision surgery were collected from Shandong Provincial Hospital from July 2016 to December 2019.Of which,78 patients were included in the study according to the inclusion and exclusion criteria.There were 33 males and 45 females,with an average age of 65.27±8.81.The above patients were divided into two groups:PJI group(41 cases)and aseptic loosening group(37 cases).The test results of preoperative blood routine,erythrocyte sedimentation rate,C-reactive protein,coagulation items,and thromboelastography were collected.Receiver operating characteristic curve(ROC)was used to calculate the sensitivity and specificity of each indicator,and the diagnostic value of each diagnostic index was compared according to the area under curve(AUC).ResultsPeripheral blood WBC,platelet count,the ratio of platelet count to mean platelet volume(MPV),CRP,ESR,D-dimer,fibrin degradation products(FDP),fibrinogen,the maximum amplitude(MA)and a angle of thromboelastogram in the PJI group was significantly higher than that in the aseptic loosening group(P<0.01).The MPV of patients in PJI group was smaller than that in the aseptic loosening group(P<0.05).The sensitivity and specificity of each indicator,the best diagnostic threshold,and the AUC size(95%confidence interval)are:D-dimer:75.61%,91.89%,0.97mg/L,0.885(0.793-0.946),FDP:78.05%,89.19%,2.98mg/L,0.893(0.802-0.951),Fib:95.12%,81.08%,3.22g/L,0.944(0.867-0.983),WBC:58.54%,81.08%,6.95×10^9/L,0.716(0.602-0.812),PLT:63.41%,97.30%,297×10^9/L,0.841(0.740-0.914),MPV:56.10%,75.68%,10.1fL,0.674(0.558-0.776),PLT/MPV:65.85%,89.19%,27.96,0.828(0.726-0.904),CRP:75.00%,94.59%,10.4mg/L,0.894(0.803-0.953),ESR:88.57%,86.11%,24mm/L,0.915(0.825-0.968),? angle:73.33%,100.00%,73.40,0.949(0.835-0.993),MA:86.67%,100.00%,68.1mm,0.976(0.876-0.999).ConclusionsThe results of this study show the clinical significance of preoperative peripheral blood coagulation tests in the diagnosis of periprosthetic joint infections.ESR and Fib have higher diagnostic value.PLT,PLT/MPV,CRP,FDP,and D-dimer are of intermediate diagnostic value.WBC is of limited diagnostic value.MPV has the lowest diagnostic value.The sensitivity and specificity of ? angle and MA in the thromboelastogram are high,with high diagnostic value.We found that ? angle and MA are referable tools for diagnosing PJI.The results may provide some advices for the diagnosis of PJI.