gms | German Medical Science

Objectives: Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in the diagnosis and management of periprosthetic joint infections (PJI). This study aims to define the normal postoperative presepsin kinetics in patients undergoing primary cementless total hip replacement (THR).

Methods: Patients undergoing primary cementless THR at our Institute were recruited. Inclusion criteria: primary osteoarthrosis of the hip; urinary catheter time of permanence <24 hours; peripheral venous cannulation time of permanence <24 hours; no postoperative homologous blood transfusion administration and hospital stay <5 days. Exclusion criteria: presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 months; diabetes mellitus; immunosuppressive drug or corticosteroid assumption.

All the patients received the same antibiotic prophylaxis. All the THR were performed by the same surgical and anaesthesia team; total operative time (TOT) was defined as the time taken from skin incision to completion of skin closure.

At enrollment anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score (HHS), drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-Reactive Protein (CRP) 24 hours before arthroplasty and at 24-, 48-, 72- and 96-hours postoperatively and at 3-, 6- and 12-months follow-up.

Statistical analysis was performed with SPSS v25.0 (SPSS Inc, Chicago, IL, USA). The Shapiro-Wilk Test was conducted. The Wilcoxon and Kruskal-Wallis tests followed by the Dunn multiple comparison post hoc tests were carried out. Correlations between PS, CRP and TOT were assessed using the Spearman rank correlation coefficient. P values below 0.05 were considered significant.

Results and conclusion: A total of 96 patients were recruited (51 female; 45 male; mean age= 65.74± 5.58) were recruited. The mean PS values were: 137.54 pg/ml at baseline, 192.08 pg/ml at 24-hours post-op; 254.85 pg/ml at 48-hours post-op; 259 pg/ml at 72-hours post-op; 248.6 pg/ml at 96-hour post-op; 140.52 pg/ml at 3-months follow-up; 135.55 pg/ml at 6-months follow-up and 130.11 pg/ml at 12-months follow-up.

In two patients (2.08%) a soft-tissue infection was observed; in these patients higher levels (>350pg/mL) were recorded at 3-months follow-up.

Based on these findings, in patients undergoing THR, we recommend assessing plasmatic PS concentration before surgery, to exclude the presence of an unknown infection; at 72-hours post-operatively, to evaluate the maximum value of presepsin and at 96-hours, post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 hours post-operatively should be a predictive factor of infection.