The Journal of Bone and Joint Surgery (American). 2005;87:1921-1927.
doi:10.2106/JBJS.D.01803
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activity for this article:
 Adult Knee Reconstruction Test 10: Fall 2005
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Di Cesare, P. E.
Right arrow Articles by Liu, C.-j.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Di Cesare, P. E.
Right arrow Articles by Liu, C.-j.
Related Collections
Right arrow Adult Knee
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Serum Interleukin-6 as a Marker of Periprosthetic Infection Following Total Hip and Knee Arthroplasty

Paul E. Di Cesare, MD1, Eric Chang, BS1, Charles F. Preston, MD1 and Chuan-ju Liu, PhD1

1 Musculoskeletal Research Center, Room 1500, NYU-Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for P.E. Di Cesare: pedicesare{at}aol.com

Investigation performed at the Musculoskeletal Research Center, NYU-Hospital for Joint Diseases, New York, NY

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The erythrocyte sedimentation rate, the C-reactive protein serum level, and the white blood-cell count are routinely used to diagnose periprosthetic infection. In the present study, the diagnostic accuracy of the interleukin-6 serum level was compared with the accuracy of these standard tests for the evaluation of a group of patients who had had a total hip or total knee arthroplasty and were undergoing a reoperation for the treatment of an infection or another implant-related problem.

Methods: A prospective, case-control study of fifty-eight patients who had had a total hip or knee replacement and were undergoing a reoperation because of an infection (seventeen patients) or another implant-related problem (forty-one patients) was conducted. The serum levels of interleukin-6 and C-reactive protein, the erythrocyte sedimentation rate, and the white blood-cell count were measured. The definitive diagnosis of an infection was determined on the basis of positive histopathological evidence of infection and growth of bacteria on culture of intraoperative specimens. Two-sample Wilcoxon rank-sum (Mann-Whitney) tests were used to determine the presence of a significant difference between patients with and without infection with regard to each laboratory value studied. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each text were also calculated.

Results: The serum interleukin-6 level, erythrocyte sedimentation rate, and C-reactive protein level were significantly higher in patients who had an infection than in those who did not, both when all patients were considered together and when the total hip arthroplasty and total knee arthroplasty groups were considered separately. With the numbers available, there was no significant difference with regard to the white blood-cell count between patients with and without infection. With a normal serum interleukin-6 level defined as <10 pg/mL, the serum interleukin-6 test had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 1.0, 0.95, 0.89, 1.0, and 97%, respectively.

Conclusions: An elevated serum interleukin-6 level correlated positively with the presence of periprosthetic infection in patients undergoing a reoperation at the site of a total hip or knee arthroplasty. The serum interleukin-6 level is valuable for the diagnosis of periprosthetic infection in patients who have had a total hip or total knee arthroplasty.

Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
J. A. Forsberg, E. A. Elster, R. C. Andersen, E. Nylen, T. S. Brown, M. W. Rose, A. Stojadinovic, K. L. Becker, and F. X. McGuigan
Correlation of Procalcitonin and Cytokine Expression with Dehiscence of Wartime Extremity Wounds
J. Bone Joint Surg. Am., March 1, 2008; 90(3): 580 - 588.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. J. Archibeck and R. E. White Jr.
What's New in Adult Reconstructive Knee Surgery
J. Bone Joint Surg. Am., July 1, 2006; 88(7): 1677 - 1686.
[Full Text] [PDF]

Home page
 JBJSHome page
T. W. Bauer, J. Parvizi, N. Kobayashi, and V. Krebs
Diagnosis of Periprosthetic Infection
J. Bone Joint Surg. Am., April 1, 2006; 88(4): 869 - 882.
[Abstract] [Full Text] [PDF]