Postoperative fever: differences between elective vs. traumatic hip, knee and shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology

Background:

• The incidence of postoperative fever (POF) after hip, knee, and shoulder arthroplasty is not well-defined.
• The impact of a trauma setting on POF rates remains uninvestigated.

Purpose of the Study:

• To compare the incidence of POF across hip, knee, and shoulder arthroplasty.
• To investigate the influence of trauma versus elective settings on POF.
• To analyze risk factors and outcomes associated with POF.

Main Methods:

• Retrospective review of 675 joint replacement surgeries (hip, knee, shoulder) between 2016-2018.
• Analysis of patient demographics, perioperative, and postoperative parameters.
• Characterization of fever curves and review of fever-related diagnostic workup costs.

Main Results:

• Overall, 13.2% of patients experienced POF (≥38.0°C), with 3.1% having POF (≥38.5°C).
• Traumatic total hip arthroplasty (THA) showed a significantly higher risk (OR 3.88) of POF (≥38.5°C) compared to elective THA (10.6% vs. 3.0%).
• POF (≥38.5°C) was associated with male gender, increased intraoperative blood loss, and longer hospital stay. Only one case of early periprosthetic joint infection was noted.

Conclusions:

• POF (≥38.5°C) is more frequent in traumatic THA than elective THA.
• No statistically significant differences in POF rates were found between joint areas when separating elective and trauma cases.
• The risk of early periprosthetic joint infection is not elevated in patients with POF, and fever workups are seldom beneficial without clinical symptoms.