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. 2023 Jan 29;12(3):1055.
doi: 10.3390/jcm12031055.

Long Pentraxin 3 as a New Biomarker for Diagnosis of Hip and Knee Periprosthetic Joint Infections

Mattia Loppini  1   2   3 , Marco Di Maio  1 , Roberta Avigni  1 , Roberto Leone  1 , Antonio Inforzato  1   2 , Guido Grappiolo  1   3 , Alberto Mantovani  1   2   4 , Barbara Bottazzi  1
Affiliations

Long Pentraxin 3 as a New Biomarker for Diagnosis of Hip and Knee Periprosthetic Joint Infections

Mattia Loppini et al. J Clin Med. .

Abstract

Background: Preoperative diagnosis of periprosthetic joint infections (PJIs) poses an unmet clinical challenge. The long pentraxin PTX3 is a component of the innate immune system involved in infection immunity. This study evaluated the potential of synovial and plasmatic PTX3 in the diagnosis of hip and knee PJIs.

Methods: Consecutive total hip and knee arthroplasty (THA/TKA) revisions were prospectively included and classified as septic or aseptic according to the European Bone and Joint Infection Society (EBJIS) and Musculoskeletal Infection Society (MSIS) criteria. The concentration of PTX3 in plasma and synovial fluid samples was measured with ELISA. The AUC, threshold value, sensitivity, specificity, and positive and negative likelihood ratios were calculated using the ROC (receiver operating characteristic) curve method.

Results: The study population included 128 patients (94 THAs; 34 TKAs). The AUC of the synovial PTX3 based on EBJIS criteria was 0.85 (p < 0.0001), with a sensitivity of 81.13% and a specificity of 93.33%. The AUC based on MSIS criteria was 0.95 (p < 0.001), with a sensitivity of 91.43% and a specificity of 89.25%. Plasmatic PTX3 failed to discriminate infected from non-infected patients.

Conclusions: Synovial PTX3 demonstrated an excellent diagnostic potential in hip and knee PJIs, with a very high specificity irrespective of the diagnostic criteria for PJI.

Keywords: biomarkers; hip; knee; pentraxin 3; periprosthetic joint infections.

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Conflict of interest statement

A.M., B.B. and A.I. are inventors of patents on PTX3. Additionally, A.M. and B.B. obtain royalties on PTX3-related reagents. M.L., G.G., M.D.M., R.A. and R.L. declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow-chart of the patients included in the study.
Figure 2
Figure 2
Concentration of PTX3 in the synovial fluid of THA and TKA patients with and without PJI, based on EBJIS and MSIS criteria (Mann-Withney test, **** p < 0.0001).
Figure 3
Figure 3
Distribution of the concentration of PTX3 in the synovial fluid of aseptic and infected patients according to surgery (TKA or THA) and EBJIS/MSIS criteria (Two Way ANOVA, **** p < 0.0001, *** p < 0.0005, * p < 0.05).
Figure 4
Figure 4
ROC curves of the concentration of PTX3 in the synovial fluid of THA and TKA patients with and without PJI (based on EBJIS and MSIS criteria).
Figure 5
Figure 5
Leukocyte count in the synovial fluid of THA and TKA patients with and without PJI (based on MSIS criteria; Mann-Withney, **** p < 0.0001) and its correlation with the concentration of PTX3 (Spearman r: 0.498, p < 0.0001).
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Grants and funding

This research received no external funding. We gratefully acknowledge the contribution of the European Research Council (ERC n° 669415) to A.M. and Fondazione Beppe & Nuccy Angiolini to A.I. and A.M.

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