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C-reactive protein during the first 6 postoperative days after total hip arthroplasty cannot predict early
Sebastian Rohe1, Sabrina Böhle2, Georg Matziolis2
1Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany. s.rohe@waldkliniken-eisenberg.de.
Insights
C-reactive protein (CRP) monitoring after total hip arthroplasty (THA) has limited value for detecting early periprosthetic joint infection (PJI). Dynamic CRP changes, not single thresholds, offer fair accuracy in identifying infection within the first week post-surgery.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Biomarker Analysis
Background:
- Periprosthetic joint infection (PJI) is a significant complication following total hip arthroplasty (THA).
- C-reactive protein (CRP) is a common inflammatory marker, but its utility in diagnosing early postoperative PJI within the first week is not well-established.
Purpose of the Study:
- To evaluate the predictive value of C-reactive protein (CRP) levels in the early postoperative period (first 6 days) for detecting acute periprosthetic joint infection (PJI) after total hip arthroplasty (THA).
Main Methods:
- Retrospective analysis of C-reactive protein (CRP) levels in patients undergoing primary THA and those with acute PJI within 28 days.
- Utilized receiver-operating curve (ROC) analysis and Youden's index to determine optimal CRP thresholds and area under the curve (AUC) for diagnostic accuracy.
Main Results:
- 33 of 7042 patients developed acute PJI. PJI patients were older, had higher BMI, longer operation times, and more comorbidities.
- CRP levels were significantly higher on postoperative days 3 and 5 in the PJI group, but calculated thresholds showed low sensitivity and specificity.
- Calculated CRP thresholds of 152 mg/l (day 3) and 73 mg/l (day 5) demonstrated poor diagnostic accuracy.
Conclusions:
- Routine inpatient C-reactive protein (CRP) monitoring in the first postoperative week after THA has questionable clinical relevance for diagnosing acute PJI.
- Area under the curve (AUC) analysis indicated poor diagnostic accuracy for CRP thresholds.
- Dynamic analysis of CRP (max to min value decrease) showed fair accuracy, suggesting this approach may be more informative than static values.
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.
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