Vol. 21 No. 1 (2022)
Original Articles

Evaluation of the serum level of C-reactive protein for diagnosing acute periprosthetic infection after total knee arthroplasty

PDF
  • Rafael E. de Paula,
  • Fabrício B. Loures,
  • Fernando Rondon,
  • Rodrigo Pires e Albuquerque,
  • Phelippe V. Maia,
  • João Maurício Barreto
DOI: https://doi.org/10.12957/bjhbs.2022.68178

Published 2022-07-04

Keywords

  • Knee,
  • Osteoarthritis,
  • Arthroplasty,
  • Infection,
  • CRP

How to Cite

1.
E. de Paula R, B. Loures F, Rondon F, Pires e Albuquerque R, V. Maia P, Barreto JM. Evaluation of the serum level of C-reactive protein for diagnosing acute periprosthetic infection after total knee arthroplasty. BJHBS [Internet]. 2022 Jul. 4 [cited 2024 Nov. 21];21(1):31-8. Available from: https://bjhbs.hupe.uerj.br/bjhbs/article/view/23

Copyright (c) 2022 Brazilian Journal of Health and Biomedical Sciences

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Crossref
Scopus
Google Scholar
Europe PMC

Abstract

Objective: To determine the serum level of C-reactive protein (CRP) with greater accuracy for diagnosing acute periprosthetic infection after total knee arthroplasty (TKA). Method: Case-control study evaluating serum levels of CRP after TKA in infected and uninfected groups. The serum levels of CRP were assessed in patients submitted to TKA who had been readmitted in the acute phase for surgical debridement with implant retention and had their diagnosis of periprosthetic infection confirmed. These values were compared with a control group, which did not present infectious complications. Results: Between March 2014 and March 2016, 1,373 TKAs were performed in the institution, and 28 patients (0.49%) were readmitted in the acute phase with a diagnosis of periprosthetic infection. Sixteen patients met the inclusion criteria. Gender, skin color, age, and body mass index (BMI) were similar between the groups. The patients in the acute periprosthetic infection group had significantly higher mean serum levels of CRP than the control group (p<0.001). For CRP levels = 30.615, the test’s highest sensitivity (75%) and specificity (77%) were achieved, with an accuracy of 77.3% for the diagnosis of infection. The area under the 0.762 Receiver Operating Characteristics (ROC) curve showed satisfactory performance of the proposed test. Conclusion: Serum levels of CRP greater than 30.615 mg/L in the third week after TKA associated with clinical signs are highly suggestive of acute periprosthetic infection.

PDF

Metrics

Metrics Loading ...

References

  1. Berger RA, Rosenberg AG, Barden RM, et al. Long-Term Followup of the Miller-Galante Total Knee Replacement. Clinical Orthopaedics & Related Research. 2001;388:58–67.
  2. Indelli PF, Aglietti P, Buzzi R, et al. The Insall-Burstein II prosthesis: A 5- to 9-year follow-up study in osteoarthritic knees. Journal of Arthroplasty. 2002;17:544–549. doi: 10.1054/arth.2002.32186. PMID: 12168167
  3. Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clinical Orthopaedics and Related Research. 2010;468:45–51. doi: 10.1007/s11999-009-0945-0. PMID: 19554385
  4. CDC - Arthritis - Basics - Definition - Osteoarthritis [Internet]. [cited 2014 Apr 24]. Available from: http://www.cdc.gov/arthritis/basics/osteoarthritis.htm.
  5. Kurtz S, Ong K, Lau E, et al. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. The Journal of Bone and Joint Surgery (American). 2007;89:780. doi: 10.2106/JBJS.F.00222. PMID: 17403800
  6. Loures FB, Góes RF de A, da Palma IM, et al. Anthropometric study of the knee and its correlation with the size of three implants available for arthroplasty. Revista Brasileira de Ortopedia. 2016;51:282–289. doi: 10.1016/j.rboe.2015.07.009. PMID: 27274481
  7. Loures FB, Góes RF de A, Labronici PJ, et al. Evaluation of body mass index as a prognostic factor in osteoarthrosis of the knee. Revista Brasileira de Ortopedia (English Edition). 2016;51:400–404. doi: 10.1016/j.rboe.2016.05.002. PMID: 27517017
  8. de Carvalho Júnior LH, Temponi EF, Badet R. Infection after total knee replacement: diagnosis and treatment. Revista Brasileira de Ortopedia (English Edition). 2013;48:389–396. doi: 10.1016/j.rboe.2013.01.003
  9. Illingworth KD, Mihalko WM, Parvizi J, et al. How to Minimize Infection and Thereby Maximize Patient Outcomes in Total Joint Arthroplasty: A Multicenter Approach. the Journal of Bone and Joint Surgery. 2013;95:1–13. doi: 10.2106/JBJS.L.00596
  10. Lentino JR. Prosthetic Joint Infections: Bane of Orthopedists, Challenge for Infectious Disease Specialists. Clinical Infectious Diseases. 2003;36:1157–1161. doi: 10.1086/374554. PMID: 12715311
  11. Matar WY, Jafari SM, Restrepo C, et al. Preventing Infection in Total Joint Arthroplasty. The Journal of Bone and Joint Surgery-American Volume. 2010;92:36–46. doi: 10.2106/JBJS.J.01046. PMID: 21123590
  12. Bedair H, Ting N, Jacovides C, et al. The Mark Coventry Award: Diagnosis of early postoperative TKA infection using synovial fluid analysis. Clinical Orthopaedics and Related Research. 2011;469:34–40. doi: 10.1007/s11999-010-1433-2. PMID: 20585914
  13. Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: From the workgroup of the musculoskeletal infection society. Clinical Orthopaedics and Related Research. 2011;469:2992–2994. doi: 10.1007/s11999-011-2102-9. PMID: 21938532
  14. Odum SM, Fehring TK, Lombardi A V, et al. Irrigation and debridement for periprosthetic infections: Does the organism matter? Journal of Arthroplasty. 2011;26:114–118. doi: 10.1016/j.arth.2011.03.031. PMID: 21621955
  15. Scott WN. Insaal & Scott Surgery of the knee. 5th ed. Philadelphia: Elsevier/Churchill Livingstone; 2012.
  16. Parvizi J, Gehrke T. Consenso internacional em infecções articulares periprotéticas. Revista Brasileira de Ortopedia. 2016
  17. Barreto JM. Centro de Cirurgia de Joelho. 10th ed. Rio de Janeiro: LTC; 2008.
  18. Garner J, Jarvis W, Emori T, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–140.
  19. Greidanus N, Masri B, Garbuz D, et al. Use of Erythrocyte Sedimentation Rate and C-Reactive Protein Level to Diagnose Infection Before Revision Total Knee Arthroplasty: A Prospective Evaluation. J Bone Joint Surg Am. 2007;89:1409–1416.
  20. Yi PH, Cross MB, Moric M, et al. The 2013 Frank Stinchfield Award: Diagnosis of infection in the early postoperative period after total hip arthroplasty. Clinical Orthopaedics and Related Research. 2014;472:424–429. doi: 10.1007/s11999-013-3089-1. PMID: 23884798
  21. Ghanem E, Parvizi J, Burnett RSJ, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. Journal of Bone and Joint Surgery - Series A. 2008;90:1637–1643. doi: 10.2106/JBJS.G.00470. PMID: 18676892
  22. Schinsky M, Della Valle C, Sporer S, et al. Perioperative Testing for Joint Infection in Patients Undergoig Revision Total Hip Arthroplasty. J Bone Joint Surg Am. 2008;90:1869–1875.
  23. Spangehl MJ, Masri BA, O’Connell JX, et al. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. The Journal of Bone and Joint Surgery American volume. 1999;81:672–683. doi: 10.1097/00003086-197209000-00020. PMID: 10360695
  24. Cipriano CA, Brown NM, Michael AM, et al. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. The Journal of Bone and Joint Surgery American volume. 2012;94:594–600. doi: 10.2106/JBJS.J.01318. PMID: 22488615
  25. Glehr M, Friesenbichler J, Hofmann G, et al. Novel biomarkers to detect infection in revision hip and knee arthroplasties. Clinical Orthopaedics and Related Research. 2013;471:2621–2628. doi: 10.1007/s11999-013-2998-3. PMID: 23609811
  26. Brimmo O, Ramanathan D, Schiltz NK, et al. Irrigation and Debridement Prior to a Two-Stage Revision Total Knee Arthroplasty Does Not Increase Risk of Failure. J Arthroplasty. 2016;31:461–464. doi: 10.1002/nbm.3369.Three. PMID: 24655651

Most read articles by the same author(s)