Speakers - 2026

Title: Corticosteroids, Not Biologics, Drive Infection Risk After Arthroplasty in Immunosuppressed Patients

Abstract

Background:

Diagnosis of Periprosthetic Joint Infection (PJI) post joint replacement has become an increasing challenge for surgeons and can have a significant impact on patient outcomes. Blood tests such as C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), and White Cell Count (WCC) are commonly used in clinical practice, but their diagnostic accuracy needs to be evaluated.

Methods:

Electronic databases were systematically reviewed for studies reporting on the sensitivity and specificity of these markers against established reference standards.

Results:

Comparative Analysis of These Biomarkers demonstrated that CRP provided higher diagnostic accuracy compared to ESR and WCC. Reported sensitivities ranged from 77% to 91% and specificities from 70% to 92%. ESR had variable sensitivities (73% to 85%) and variation in optimal threshold values. WCC was identified as having limited diagnostic utility as a serum marker.

There was significant heterogeneity in studies regarding optimal cut-off values, assessment timing, and organism virulence. Low-virulence organisms (i.e. coagulase-negative staphylococci) were associated with significantly lower increases in inflammatory markers and higher false negatives. Combination testing improved diagnostic performance. However, no single marker had sufficient accuracy for a standalone diagnosis.

Continuing biologics during surgery does not significantly increase the risk of surgical site infections (OR 1.11) or wound complications (OR 2.16) and reduces the risk of disease flare-ups (OR 0.22). After adjusting for steroid use, biologics do not significantly increase the risk of PJI.

Conclusions:

Although inflammatory markers have valuable screening information in suspected PJI, their diagnostic limitations (organism-dependent sensitivity and false negative rates) impact their use as definitive diagnostic tools. Synovial fluid analysis and microbiology culture can assist with accurate diagnosis.