Course of fever and potential infection after total joint replacement

The purpose of this study was to determine the relationship between fever, including different patterns of fever, and infection in patients who received total hip arthroplasty or knee arthroplasty (THA or TKA).

Fever was defined as a core body temperature ≥38.0 °C and was further categorized as being (1) consecutive fever (fever lasting three or more days) or (2) fever with body temperature ≥39 °C. Medical records of patients who underwent total joint arthroplasty (TJA) between November 2009 and February 2012 were retrospectively examined, and those who underwent one primary TJA procedure were considered for inclusion.

A total of 980 patients (TKA = 597, THA = 383) were included. Overall, 48.2% of patients experienced fever, most commonly on postoperative day 1, and the maximum body temperature also most commonly occurred on postoperative day 1. Respiratory, urinary tract, periprosthetic, and any infections were significantly associated with consecutive fever (P < 0.05), while respiratory and any infections were significantly associated with fever ≥39 °C. Multivariate analysis revealed that patients who experienced infection had a significantly increased risk of postoperative fever (P = 0.001).

Consecutive fevers or fever ≥39 °C after TJA may be indicative of postoperative infection, and testing to rule out infection should be performed. These results may assist in the differential diagnosis of postoperative fever after TJA and thus help to guide treatment.

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