As the number of patients receiving total joint replacements continues to rise,considerable attention has been directed towards the early detection and prevention of postoperative complications.While D-dimer has long ...As the number of patients receiving total joint replacements continues to rise,considerable attention has been directed towards the early detection and prevention of postoperative complications.While D-dimer has long been studied as a diagnostic tool in venous thromboembolism(VTE),this assay has recently received considerable attention in the diagnosis of periprosthetic joint infection(PJI).D-dimer values are substantially elevated in the acute postoperative period after total joint arthroplasty,with levels often exceeding the standard institutional cutoff for VTE(500µg/L).The utility of D-dimer in detecting VTE after total joint replacement is currently limited,and more research to assess its value in the setting of contemporary prophylaxis protocols is warranted.Recent literature supports D-dimer as a good to excellent biomarker for the diagnosis of chronic PJI,especially when using serum sample technique.Providers should exercise caution when interpreting D-dimer levels in patients with inflammatory and hypercoagulability disorders,as the diagnostic value is decreased.The updated 2018 Musculoskeletal Infection Society criteria,which includes D-dimer levels>860µg/L as a minor criterion,may be the most accurate for diagnosing chronic PJI to date.Larger prospective trials with transparent lab testing protocols are needed to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of PJI.This review summarizes the most current literature on the value of D-dimer in total joint arthroplasty and elucidates areas for future progress.展开更多
While advanced technology,increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty,prosthetic joint infection still remains one of the leading causes of inc...While advanced technology,increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty,prosthetic joint infection still remains one of the leading causes of increased healthcare costs,medical resources and societal burdens in orthopaedic care.Two stage arthroplasty revision remains the gold standard for treatment of prosthetic joint infection.Proponents of single stage revision arthroplasty for infection argue that it results in lower healthcare costs while improving patient reported functional outcomes and with equivalent success rates.Here we review the history of single stage revision arthroplasty,discuss the key principles,highlight the indications and contraindications,and review the reported outcomes with a focus on future developments of single stage revision arthroplasty for hip and knee periprosthetic joint infections.展开更多
文摘As the number of patients receiving total joint replacements continues to rise,considerable attention has been directed towards the early detection and prevention of postoperative complications.While D-dimer has long been studied as a diagnostic tool in venous thromboembolism(VTE),this assay has recently received considerable attention in the diagnosis of periprosthetic joint infection(PJI).D-dimer values are substantially elevated in the acute postoperative period after total joint arthroplasty,with levels often exceeding the standard institutional cutoff for VTE(500µg/L).The utility of D-dimer in detecting VTE after total joint replacement is currently limited,and more research to assess its value in the setting of contemporary prophylaxis protocols is warranted.Recent literature supports D-dimer as a good to excellent biomarker for the diagnosis of chronic PJI,especially when using serum sample technique.Providers should exercise caution when interpreting D-dimer levels in patients with inflammatory and hypercoagulability disorders,as the diagnostic value is decreased.The updated 2018 Musculoskeletal Infection Society criteria,which includes D-dimer levels>860µg/L as a minor criterion,may be the most accurate for diagnosing chronic PJI to date.Larger prospective trials with transparent lab testing protocols are needed to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of PJI.This review summarizes the most current literature on the value of D-dimer in total joint arthroplasty and elucidates areas for future progress.
文摘While advanced technology,increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty,prosthetic joint infection still remains one of the leading causes of increased healthcare costs,medical resources and societal burdens in orthopaedic care.Two stage arthroplasty revision remains the gold standard for treatment of prosthetic joint infection.Proponents of single stage revision arthroplasty for infection argue that it results in lower healthcare costs while improving patient reported functional outcomes and with equivalent success rates.Here we review the history of single stage revision arthroplasty,discuss the key principles,highlight the indications and contraindications,and review the reported outcomes with a focus on future developments of single stage revision arthroplasty for hip and knee periprosthetic joint infections.
