Dosage de la protéine C-réactive dans le liquide articulaire lors des reprises de prothèse totale de hanche et de genou : intérêt dans le diagnostic des infections sur prothèse : étude cas / témoin

Abstract : Introduction: prosthetic joint infection (PJI) diagnosis remain difficult and based on an argument cluster. New diagnostic markers assays from the intra-articular fluid have been evaluated. The objective of our study is to evaluate the interest of the intra-articular CRP assay for PJI diagnosis. Methods: 194 patients were included in a single-center prospective study: 42 patients undergoing primary knee or hip arthroplasty (T group), 111 patients undergoing revision of aseptic prosthesis (RA group) and 41 patients undergoing revision of PJI (RS group) according to the criteria of the Society of Musculoskeletal Infection were included. The serum and synovial C-reactive protein assay was calculated by turbidimetric or nephelometric method.
Results: serum and synovial CRP levels were significantly increased in the RS group compared with the two others groups (75.6 mg/L vs 6 mg/L and 2.7 mg/L, p <0.001; 31.5 mg/L vs 2.6 mg/L and 1.7 mg/L, p <0.001). The likelihood ratios with the selected cut-offs suggested superiority of synovial CRP assay: a threshold value greater than 4.4 mg / L suggested a probable prosthetic joint infection (sensitivity 82.5%, specificity 88.3%). The likelihood ratios with the selected cut-offs suggested superiority of serum CRP assay to eliminate the diagnosis of prosthetic joint infection, with a threshold value of 7.5mg/L (sensitivity 90%, specificity 91%).
Conclusion: this study confirms the interest of synovial CRP assay for the diagnosis of prosthetic joint infection. It could be used as an additional criterion in the diagnostic process.
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César Praz. Dosage de la protéine C-réactive dans le liquide articulaire lors des reprises de prothèse totale de hanche et de genou : intérêt dans le diagnostic des infections sur prothèse : étude cas / témoin. Médecine humaine et pathologie. 2018. ⟨dumas-02024545⟩

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