Periprosthetic infection diagnosis utilizing synovial c reactive protein
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Abstract
Synovial quantification of C Reactive Protein (SCRP) has been recently published with high sensitivity and specificity in the diagnosis of periprosthetic joint infection. However, there are no studies comparing the usefulness of this test with intra operative frozen section (FS), which has been used as gold standard to rule out infections at our center. We asked whether intraoperative SCRP could lead to similar sensitivity, specificity, and predictive values as intraoperative FS in revision total hip arthroplasty (THA). A prospective and comparative study (study level II) was performed including 76 patients who underwent a hip revision surgery for any cause. SCRP quantification and the analysis of FS of intraoperative samples were performed in all the patients. The definitive diagnosis of an infection was determined according to the Musculoskeletal Infection Society. We found infection in 23 patients. At a threshold of SCRP of 9.5 mg/L the sensitivity was 90% (CI 95%:70.8-98.6%), the specificity was 94% (CI 95%: 84.5-98.7%), the positive predictive value was 87% (CI95%: 66.3- 97%) and the negative predictive value was 96% (CI95%: 8799.4%), being exactly the same results when we confronted SCRP values with FS analysis. The positive LRatio was 16.36 (CI 95%=5.4-49.5), and the negative LRatio was 0.10 (CI 95%= 0.03-0.36). The quantification of SCRP has similar sensitivity, specificity and predictive values as frozen section, with the advantages of being a simple and economic test, widely available in different centers, where frozen section analysis may not be accesible
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