C-reactive protein during the first 6 postoperative days after total hip arthroplasty cannot predict early periprosthetic infection.

Autor: Rohe S; Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany. s.rohe@waldkliniken-eisenberg.de., Böhle S; Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany., Matziolis G; Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany., Jacob B; Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany., Wassilew G; Department of Orthopaedic Surgery, University Hospital Greifswald, 17475, Greifswald, Germany., Brodt S; Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2023 Jun; Vol. 143 (6), pp. 3495-3503. Date of Electronic Publication: 2022 Aug 09.
DOI: 10.1007/s00402-022-04565-4
Abstrakt: Introduction: Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) remains a serious complication in orthopaedic surgery. C-reactive protein (CRP) is widely used as a marker to screen for inflammatory complications. The early postoperative course is well known, but knowledge about the predictive value of CRP in the first 6 postoperative days for detecting an acute postoperative PJI is lacking.
Methods: We retrospectively analyzed the inpatient course of CRP of all primary THA and THA with acute PJI within 28 days in our hospital from 2013 to 2021. A receiver-operating curve (ROC) analysis was performed and the best CRP threshold for detecting an acute PJI based on Youden's-index was calculated and an area-under-the curve (AUC) analysis of the threshold was performed.
Results: 33 of 7042 patients included had an acute PJI within 28 days. Patients with acute PJI were older, had a higher BMI and longer operation time and suffered more often from diabetes mellitus. A preoperatively elevated CRP was a risk factor for PJI. CRP was significantly higher in the PJI group on postoperative days 3 and 5. Threshold values were calculated to be 152 mg/l on day 3 and 73 mg/l on day 5. However, these values had a low sensitivity (75%, 76%) and specificity (67%, 61%).
Conclusion: Especially considering the decreasing length of stay after THA, the question of the usefulness of regular inpatient CRP checks arises. AUC analysis of the ROC showed a poor diagnostic accuracy in almost all cases. Only the dynamic analysis of the maximum CRP value to the lowest CRP value with a decrease of 102.7 mg/l showed a fair accuracy. This calls into question the clinical relevance of CRP in the first postoperative week for detection of acute postoperative PJI.
(© 2022. The Author(s).)
Databáze: MEDLINE
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