Serum biomarkers in periprosthetic joint infections

OBJECTIVES

The diagnosis of periprosthetic joint infection (PJI) is difficult and requires a battery of tests and clinical findings. The purpose of this review is to summarize all current evidence for common and new serum biomarkers utilized in the diagnosis of PJI.

METHODS

We searched two literature databases, using terms that encompass all hip and knee arthroplasty procedures, as well as PJI and statistical terms reflecting diagnostic parameters. The findings are summarized as a narrative review.

RESULTS

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the two most commonly published serum biomarkers. Most evidence did not identify other serum biomarkers that are clearly superior to ESR and CRP. Other serum biomarkers have not demonstrated superior sensitivity and have failed to replace CRP and ESR as first-line screening tests. D-dimer appears to be a promising biomarker, but more research is necessary. Factors that influence serum biomarkers include temporal trends, stage of revision, and implant-related factors (metallosis).

CONCLUSION

Our review helped to identify factors that can influence serum biomarkers' level changes; the recognition of such factors can help improve their diagnostic utility. As such, we cannot rely on ESR and CRP alone for the diagnosis of PJI prior to second-stage reimplantation, or in metal-on-metal or corrosion cases. The future of serum biomarkers will likely shift towards using genomics and proteomics to identify proteins transcribed via messenger RNA in response to infection and sepsis.Cite this article:Bone Joint Res 2018;7:85-93.

[Kimura disease. Apropos of a case with review of the literature]

Kimura's disease is an uncommon chronic inflammatory disease of unknown etiology often associated with an important category of reactive lymphadenopathy in Oriental populations. The enlarged nodes are mostly located in the head and neck region. The main pathologic changes in the lymph nodes include florid germinal centers, Warthin-Finkeldey polykaryocytes, vascularization of the germinal centers, increased postcapillary veinules in the paracortex, eosinophilic infiltration and fibrosis. The disease is often confused with angiolymphoid hyperplasia with eosinophilia. Because the adenopathy may be the sole presentation of the disease, the accurate diagnosis may spare the patients unnecessary medical and/or surgical treatment. We report a case of cervical lymphadenopathy as a sole presentation of Kimura's disease.

Fertility policy and family planning in the Arab countries

An increasing number of Arab countries are instituting family planning programs to lower their populations' high fertility rates. This article examines Arab governments' perceptions of their countries' fertility situation, their desire to intervene in order to reduce or increase the rate of population growth, and the measures they have taken to influence the level of fertility. Special attention is given to family planning programs and access to methods of fertility regulation. A combination of stronger program effort and improved socioeconomic conditions account for much of the variation in contraceptive prevalence rates in 11 countries. Socioeconomic setting and political factors are found to be of primary importance in determining Arab fertility policies.