Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2023; 14(3): 90-102
Published online Mar 18, 2023. doi: 10.5312/wjo.v14.i3.90
Utility of D-dimer in total joint arthroplasty
Brenden Cutter, Zachary C Lum, Mauro Giordani, John P Meehan
Brenden Cutter, Department of Orthopedic Surgery, Valley Orthopedic Surgery Residency/Valley Consortium for Medical Education, Modesto, CA 95351, United States
Zachary C Lum, Mauro Giordani, John P Meehan, Department of Orthopaedics, Adult Reconstruction Division, University of California, Davis Medical Center, Sacramento, CA 95817, United States
Author contributions: Lum ZC and Meehan JP contributed to conceptualization; Cutter B contributed to literature search; Cutter B contributed to original draft writing/preparation; Giordani M, Lum ZC, and Meehan JP contributed to review and editing.
Conflict-of-interest statement: Brenden Cutter, Zachary Lum, Mauro Giordani, and John Meehan declare that they have no conflict of interest. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brenden Cutter, DO, Doctor, Department of Orthopedic Surgery, Valley Orthopedic Surgery Residency/Valley Consortium for Medical Education, 1400 Florida Ave #102, Modesto, CA 95351, United States. bcutter16@gmail.com
Received: July 30, 2022
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
Abstract

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.

Keywords: D-dimer; Diagnosis; Periprosthetic joint infection; Venous thromboembolism; Deep vein thrombosis; Arthroplasty

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.