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Review
. 2023 Mar 18;14(3):90-102.
doi: 10.5312/wjo.v14.i3.90.

Utility of D-dimer in total joint arthroplasty

Brenden Cutter  1 , Zachary C Lum  2 , Mauro Giordani  2 , John P Meehan  2
Affiliations
Review

Utility of D-dimer in total joint arthroplasty

Brenden Cutter et al. World J Orthop. .

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

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Pathophysiology of D-dimer formation. TXA: Tranexamic acid.
Figure 2
Figure 2
D-dimer levels after total joint arthroplasty. TXA: Tranexamic acid. References: Zhang et al[52], Lee et al[51], Bytniewski et al[50], Azboy et al[46].
See this image and copyright information in PMC

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