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Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection

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Authors
Lee, Yong Seuk; Lee, Young-Kyun; Han, Seung Bum; Nam, Chang Hyun; Parvizi, Javad; Koo, Kyung-Hoi
Issue Date
2018-02-13
Publisher
BioMed Central
Citation
Journal of Orthopaedic Surgery and Research, 13(1):36
Keywords
D-DimerPeriprosthetic joint infectionTotal hip arthroplastyTotal knee arthroplasty
Abstract
Background
Early detection followed by prompt intervention is essential for the treatment of periprosthetic joint infection (PJI). D-dimer, a fibrin degradation product, characteristically changes rapidly during early postoperative period and has a short half-life. The aim of this prospective study was to measure postoperative change of D-dimer level after joint arthroplasty in conjunction with ESR and CRP.

Methods
ESR, CRP, and D-dimer levels were measured on the day before surgery, postoperative days 1, 2, 3, and 5 and weeks 2 and 6 in 65 patients who underwent elective primary total hip arthroplasty (38 hips in 38 patients) or total knee arthroplasty (27 knees in 27 patients). We compared perioperative changes of the three biomarkers.

Results
ESR level was elevated from postoperative day 1 and reached a peak level of 45 mm/h at postoperative day 5. The elevation persisted until postoperative week 6. CRP level was elevated from postoperative day 1 and reached a peak level of 10 mg/dl between postoperative day 2 and day 3. The CRP level was decreased to the normal level around postoperative week 2. D-dimer level was sharply elevated and peaked to 4.5 μg/dl at postoperative day 1. At postoperative day 2, it decreased to baseline level. After then, it slowly elevated again and reached a second peak at postoperative week 2.

Conclusion
D-dimer showed a more rapid rise and fall than ESR and CRP in very early postoperative period. The D-dimer test might be effective in early detection of PJI, if combined with levels of ESR and CRP. The postoperative change of D-dimer in our study can serve as a baseline for early diagnosis of PJI.
ISSN
1749-799X
Language
English
URI
http://hdl.handle.net/10371/139588
DOI
https://doi.org/10.1186/s13018-018-0730-4
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College of Medicine/School of Medicine (의과대학/대학원)Orthopedic Surgery (정형외과학전공)Journal Papers (저널논문_정형외과학전공)
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