Is D-dimer a Reliable Serum Marker for Shoulder Periprosthetic Joint Infection?
Using a series of 94 patients undergoing revision total shoulder arthroplasty (anatomic or reverse), these authors sought to determine the diagnostic value of D-dimer in the patients' serum for periprosthetic infection.
Patient records were reviewed to classify patients according to the International Consensus Meeting (ICM) definitions of periprosthetic shoulder infection: "definitely" having infection (4%), "probably" having infection (15%), "possibly" having infection (14%), or "unlikely" to have an infection (67%),
D-dimer was elevated in patients meeting the ICM definitions of "definite" or "probable" infections (median [range] 661 ng/mL [150 to 8205]) compared with those with "possible" infections or those who were "unlikely to have an infection: (263 ng/mL [150 to 3060]. (Note the substantial overlap of the ranges). In the receiver operating characteristic curve analysis, D-dimer had an area under the curve of 0.71 (0.50-0.92), demonstrating weak diagnostic value.
The authors conclude that, "D-dimer appears to do little to improve the work-up of painful shoulder arthroplasty.
Comment: It is recognized that Cutibacterium is the most common organism causing shoulder periprosthetic infection. In this study, it is of interest that the D-dimer levels of the 25 revised shoulders that were culture positive for Cutibacterium, were not different from the 55 revised shoulders that were culture negative (see graph below). By contrast the 14 shoulders that were culture positive for other bacteria had higher D-dimer levels than either the culture negative or Cutibacterium-positive shoulders.
