The Utility of Serum D-Dimer for the Diagnosis of Periprosthetic Joint Infection in Revision Total Hip and Knee Arthroplasty

Background: There is scarce and contradicting evidence supporting the use of serum D-dimer for the diagnosis of periprosthetic joint infection in revision total hip (THA) and knee (TKA) arthroplasty. Therefore, the purpose of this study is to test the accuracy of serum D-dimer against the 2013 International Consensus Meeting (ICM) criteria. Methods: A retrospective review was performed on a consecutive series of 172 revision THA/TICS surgeries performed by 3 fellowship-trained surgeons at a single institution (August 2017 to May 2019) and that had D-dimer performed during their preoperative workup. Of this cohort, 111 (42 THAs/69 TKAs) cases had complete 2013 ICM criteria tests and were included in the final analysis. Septic and aseptic revisions were categorized per 2013 ICM criteria ("gold standard") and compared against serum D-dimer using an established threshold (850 ng/mL). Sensitivity, specificity, likelihood ratios, and positive/negative predictive values were determined. Independent t-tests, Fisher's exact tests, chi-squared tests, and receiver operating characteristic curve analysis were performed. Results: There was no statistically significant difference in baseline demographics between septic and aseptic cases per 2013 ICM criteria. When compared to ICM criteria, D-dimer demonstrated high sensitivity (95.9%) and negative predictive value (90.9%) but low specificity (32.3%), positive predictive value (52.8%), and overall, poor accuracy (61%) to diagnose periprosthetic joint infection. Positive likelihood ratio was 1.42 while negative likelihood ratio was 0.13. The area under the curve (AUC) was 0.742. Conclusion: Serum D-dimer has poor accuracy to discriminate between septic and aseptic cases using a described threshold in the setting of revision THA and TKA. (C) 2020 Elsevier Inc. All rights reserved.