Pentraxin 3, a new biomarker for the diagnosis and management of PJI in primary and revision hip arthroplasty

Giandomenico Logroscino; Andrea Fidanza; Ilaria Giusti; Giuseppina Poppa; Luca Troianello; Francesco Calafiore; Michela Saracco; Roberta Avigni; Roberto Leone; Alberto Mantovani; Barbara Bottazzi; Guido Grappiolo; Mattia Loppini

doi:10.23750/abm.v94iS2.13770

Pentraxin 3, a new biomarker for the diagnosis and management of PJI in primary and revision hip arthroplasty

Authors

Giandomenico Logroscino https://orcid.org/0000-0003-1301-5343
Andrea Fidanza https://orcid.org/0000-0001-7766-0806
Ilaria Giusti
Giuseppina Poppa
Luca Troianello
Francesco Calafiore
Michela Saracco a:1:{s:5:"en_US";s:45:"Università Cattolica del Sacro Cuore di Roma";} https://orcid.org/0000-0003-2190-9574
Roberta Avigni
Roberto Leone
Alberto Mantovani
Barbara Bottazzi
Guido Grappiolo
Mattia Loppini

DOI: https://doi.org/10.23750/abm.v94iS2.13770

Keywords:

Pentraxin, Hip arthroplasty, THA, Revision hip arthroplasty, PJI, infection, periprosthetic joint infections, Biomarker, Synovial fluid, Prevention

Abstract

Background/Aim of the study: The periprosthetic or superficial site infections are one of the most catastrophic and difficult to manage complications following total hip arthroplasty. Recently, in addition to well know systemic markers of inflammation, the blood and synovial fluid biomarkers are focused to have a possible role in the infection diagnosis. The long Pentraxin 3 (PTX3) seems to be a sensitive biomarker of acute phase inflammation. The objectives of this prospective and multicentre study were (1) to establish the plasma trend effectiveness of PTX3 in patients undergoing primary hip replacement, and (2) to evaluate the diagnostic accuracy of blood and synovial PTX3 in patients undergoing prosthetic revision of infected hip arthroplasty.

Methods: Human PTX3 was measured by ELISA in two cohorts of patients, 10 patients undergoing primary hip replacement for osteoarthritis and 9 patients with infected hip arthroplasty.

Results: The Authors were able to demonstrate that PTX3 is a viable biomarker for acute phase inflammation.

Conclusions: An increase in PTX3 protein concentration in the synovial fluid of patients undergoing implant revision has a strong diagnostic capacity for periprosthetic joint infection, showing 97% specificity.

References

Fidanza A, Schettini I, Palozzi G, Mitrousias V, Logroscino G, Romanini E, Calvisi V. What Is the Inpatient Cost of Hip Replacement? A Time-Driven Activity Based Costing Pilot Study in an Italian Public Hospital. J Clin Med. 2022 Nov 24;11(23):6928. 10.3390/jcm11236928.

Vicenti G, Bizzoca D, Nappi V, et al. Serum biomarkers in the diagnosis of periprosthetic joint infection: consolidated evidence and recent developments. Eur Rev Med Pharmacol Sci. 2019; 23(2Suppl):43-50. 10.26355/eurrev_201904_17473.

Iannotti F, Prati P, Fidanza A, et al. Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients. Trop Med Infect Dis. 2020; 5(4):186. 10.3390/tropicalmed5040186.

Parvizi J, Tan TL, Goswami K, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018; 33(5):1309-14. 10.1016/j.arth.2018.02.078.

Zmistowski B, Della Valle C, Bauer TW, et al. Diagnosis of periprosthetic joint infection. J Arthroplasty 2014; 29:77-83. https://doi.org/10.1016/j.arth.2013.09.040

Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Diagnosing periprosthetic joint infection: has the era of the biomarker arrived? Clin Orthop Relat Res 2014; 472:3254-62. https://doi. org/10.1007/s11999-014-3543-8

Drago L, Romanò D, Fidanza A, Giannetti A, Erasmo R, Mavrogenis AF, Romanò CL. Dithiotreitol pre-treatment of synovial fluid samples improves microbiological counts in peri-prosthetic joint infection. Int Orthop. 2023 May;47(5):1147-1152. 10.1007/s00264-023-05714-z

Garlanda C, Jaillon S, Doni A, Bottazzi B, Mantovani A. PTX3, a humoral pattern recognition molecule at the interface between microbe and matrix recognition. Curr Opin Immunol 2016; 38:39-44. https://doi.org/10.1016/j.coi.2015.11.002

Jaillon S, Moalli F, Ragnarsdottir B, et al. The humoral pattern recognition molecule PTX3 is a key component of innate immunity against urinary tract infection. Immunity 2014; 40:62132. https://doi.org/10.1016/j.immuni.2014.02.015

Mauri T, Coppadoro A, Bombino M, et al. Alveolar pentraxin 3 as an early marker of microbiologically confirmed pneumonia: a threshold-finding prospective observational study. Crit Care 2014; 18:562. https://doi.org/10.1186/s13054-0140562-5

Mauri T, Bellani G, Patroniti N, et al. Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality. Intensive Care Med 2010; 36:621-9. https://doi.org/10.1007/s00134010-1752-5

Garlanda C, Bottazzi B, Bastone A, Mantovani A. Pentraxins at the crossroads between innate immunity, inflammation, matrix deposition, and female fertility. Annu Rev Immunol. 2005; 23:337-66. 10.1146/annurev.immunol.23.021704.115756.

Cancienne JM, Werner BC, Bolarinwa SA, Browne JA. Removal of an infected total hip arthroplasty: risk factors for repeat debridement, long-term spacer retention, and mortality. J Arthroplasty 2017; 32: 2519–22. 10.1016/j.arth.2017.03.018.

Emsley J, White HE, O'Hara BP, et al. Structure of pentameric human serum amyloid P component. Nature 1994; 367:338–45. https://doi.org/10.1038/367338a0

Daigo K, Inforzato A, Barajon I, et al. Pentraxins in the activation and regulation of innate immunity. Immunol Rev 2016; 274:202-17. https://doi.org/10.1111/imr.12476

Porte R, Davoudian S, Asgari F, et al. The Long Pentraxin PTX3 as a Humoral Innate Immunity Functional Player and Biomarker of Infections and Sepsis. Front Immunol. 2019; 10:794. 10.3389/fimmu.2019.00794.

Huang ZY, Huang Q, Wang LY, et al. Normal trajectory of Interleukin-6 and C-reactive protein in the perioperative period of total knee arthroplasty under an enhanced recovery after surgery scenario. BMC Musculoskelet Disord. 2020; 21(1):264. 10.1186/s12891-020-03283-5.

Tetreault MW, Wetters NG, Moric M, Gross CE, Della Valle CJ. Is synovial C-reactive protein a useful marker for periprosthetic joint infection? Clin Orthop Relat Res. 2014; 472(12):3997-4003. 10.1007/s11999-014-3828-y.

Bilgen O, Atici T, Durak K, Karaeminoğullari, Bilgen MS.C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res. 2001; 29(1):7-12. 10.1177/147323000102900102

Ahmad SS, Hirschmann MT, Becker R, et al. A meta-analysis of synovial biomarkers in periprosthetic joint infection: synovasure is less effective than the ELISA-based alpha-defensin test. Knee Surg Sports Traumatol Arthrosc 2018; 26:3039- 47. https://doi.org/10.1007/s00167-018-4904-8

Ghirardelli S, Fidanza A, Prati P, Iannotti F, Indelli PF. Debridement antibiotic pearls and retention of the implant in the tratment of infected total hip arthroplary. Hip Int. 2020; 30(1suppl):34-41. 10.1177/1120700020929314.

Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005; 87(8):1746-51. 10.2106/JBJS.D.02937.

Ghirardelli S, Touloupakis G, Antonini G, Violante B, Fidanza A, Indelli PF (2022) Debridement, antibiotic, pearls, irrigation and retention of the implant and other local strategies on hip periprostetic joint infections. Minerva Orthopedics 73(4):409–15. 10.23736/S2784-8469.21.04173-0.

Goswami K, Parvizi J, Maxwell Courtney P. Current Recommendations for the Diagnosis of Acute and Chronic PJI for Hip and Knee-Cell Counts, Alpha-Defensin, Leukocyte Esterase, Next-generation Sequencing. Curr Rev Musculoskelet Med. 2018; 11(3):428-38. 10.1007/s12178-018-9513-0.

Solarino G, Abate A, Vicenti G, Spinarelli A, Piazzolla A, Moretti B. Reducing periprosthetic joint infection: what really counts? Joints. 2016; 3(4):208-14. 10.11138/jts/2015.3.4.208.

Gehrke T, Alijanipour P, Parvizi J. The management of an infected total knee arthroplasty. Bone Joint J. 2015; 97B(10Suppl):20-9. 10.1302/0301-620X.97B10.36475.