• Arch Orthop Trauma Surg · Dec 2024

    Review Meta Analysis

    Latent infections in conversion total hip arthroplasty following internal fixation of femoral neck fractures: a systematic review and meta-analysis of diagnostic methods.

    • Mohammad Poursalehian, Mohadeseh Lotfi, and MortazaviSeyed Mohammad JavadSMJ0000-0003-4189-7777Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. smjmort@yahoo.com.Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical .
    • Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
    • Arch Orthop Trauma Surg. 2024 Dec 1; 144 (12): 507950875079-5087.

    BackgroundAccurate diagnosis of latent infections prior to conversion total hip arthroplasty (THA) following internal fixation of femoral neck fractures is crucial for successful surgical outcomes. This systematic review aimed to provide a comprehensive evaluation of the current literature regarding the diagnosis of latent infections before conversion THA.MethodsSystematic search of PubMed, EMBASE, and Cochrane (CENTRAL) databases was conducted, and the diagnostic accuracy of various markers and techniques was assessed. The quality of the included studies was evaluated using the QUADAS-2 instrument.ResultsFive studies comprising 661 patients were included in the review. Pooled analysis using C-reactive protein (CRP) as a diagnostic marker resulted in a sensitivity and specificity of 72% and 76%, respectively, while using erythrocyte sedimentation rate (ESR) yielded a sensitivity and specificity of 75% and 78%, respectively. Fibrinogen and platelet count showed lower sensitivity and specificity compared to CRP and ESR. The best combined markers were CRP and serum platelet count, with a sensitivity of 76% and specificity of 86% based on one study.ConclusionOur review underscored the limitations and inconsistencies present in current diagnostic methods for latent infections in conversion surgery. Future research needs to focus on standardizing threshold values, exploring the potential of synovial fluid analysis, imaging techniques, and molecular methods, as well as developing tailored diagnostic algorithms.ProsperoCRD42023394757.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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