# Continuous monitoring of serum markers for early detection of periprosthetic joint infection in osteoporotic patients undergoing hip arthroplasty: A prospective cohort study

## TL;DR

This study evaluates serum markers for early detection of joint infections in osteoporotic patients after hip surgery, finding that certain markers reliably detect infections early.

## Contribution

The study introduces a reliable combination of serum markers for early detection of periprosthetic joint infection in osteoporotic patients.

## Key findings

- CRP, PCT, ESR, D-dimer, WBC, sCD14, and SAA were significantly higher in infected patients at 48 hours post-surgery.
- A combination of CRP, D-dimer, WBC, sCD14, and SAA achieved 90% sensitivity and 92% specificity for PJI detection.
- Ferritin and MMP-9 showed higher values in infected patients but did not reach statistical significance.

## Abstract

Periprosthetic joint infection (PJI) is a significant complication following hip arthroplasty, especially in osteoporotic patients. Early detection is crucial for improving outcomes but remains challenging. This study assesses the effectiveness of continuous monitoring of serum markers - C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), D-dimer, white blood cell count (WBC), ferritin, soluble CD14 (sCD14), matrix metalloproteinase-9 (MMP-9), and serum amyloid A (SAA) - for early detection of PJI in osteoporotic patients undergoing hip arthroplasty.

A prospective cohort study included 150 osteoporotic patients undergoing hip arthroplasty. Inflammatory markers were measured preoperatively and at 24-, 48-, and 72 hours post-surgery, with weekly follow-ups for 6 weeks. PJI was diagnosed based on clinical, microbiological, and imaging criteria. The diagnostic performance of individual markers was assessed using Receiver Operating Characteristic (ROC) curves.

Among the 150 patients, 12 (8%) developed PJI within 6 weeks. At 48 hours post-surgery, CRP PCT, ESR, D-dimer, WBC, sCD14, and SAA were significantly higher in the PJI group compared to the non-infected group (p< 0.05 for all). Ferritin and MMP-9 levels showed higher values in the infected group but did not reach statistical significance (p= 0.076 and p= 0.094, respectively). The combination of CRP D-dimer, WBC, sCD14, and SAA demonstrated 90% sensitivity and 92% specificity for PJI detection.

Continuous monitoring of CRP, D-dimer, WBC, sCD14, and SAA offers a reliable approach for early detection of PJI in osteoporotic patients undergoing hip arthroplasty. These markers showed strong associations with infection, while ferritin and MMP-9 were less informative. This strategy may help improve early diagnosis and patient outcomes.