Published online Mar 18, 2023. doi: 10.5312/wjo.v14.i3.90
Peer-review started: July 30, 2022
First decision: October 24, 2022
Revised: November 22, 2022
Accepted: February 13, 2023
Article in press: February 13, 2023
Published online: March 18, 2023
Processing time: 229 Days and 17.8 Hours
As the number of patients receiving total joint replacements continues to rise, considerable attention has been directed towards the early detection and prevention of postoperative complications. While D-dimer has long been studied as a diagnostic tool in venous thromboembolism (VTE), this assay has recently received considerable attention in the diagnosis of periprosthetic joint infection (PJI). D-dimer values are substantially elevated in the acute postoperative period after total joint arthroplasty, with levels often exceeding the standard institutional cutoff for VTE (500 µg/L). The utility of D-dimer in detecting VTE after total joint replacement is currently limited, and more research to assess its value in the setting of contemporary prophylaxis protocols is warranted. Recent literature supports D-dimer as a good to excellent biomarker for the diagnosis of chronic PJI, especially when using serum sample technique. Providers should exercise caution when interpreting D-dimer levels in patients with inflammatory and hypercoagulability disorders, as the diagnostic value is decreased. The updated 2018 Musculoskeletal Infection Society criteria, which includes D-dimer levels > 860 µg/L as a minor criterion, may be the most accurate for diagnosing chronic PJI to date. Larger prospective trials with transparent lab testing protocols are needed to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of PJI. This review summarizes the most current literature on the value of D-dimer in total joint arthroplasty and elucidates areas for future progress.
Core Tip: Venous thromboembolism (VTE) and periprosthetic joint infection (PJI) are potentially devastating complications after total joint arthroplasty. D-dimer has limited utility with current cutoff values in the detection of VTE in the acute postoperative period. The D-dimer assay is a valuable biomarker in the diagnosis of chronic periprosthetic joint infection, and its utility may be optimized by using serum sample technique. Larger prospective trials with transparent lab testing protocols are necessary to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of VTE and PJI in arthroplasty patients.