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Pyrexia after total knee replacement. A cause for concern?

J G Kennedy1, W B Rodgers, D Zurakowski

  • 1Department of Surgery, Mater Misericordiae Hospital, Dublin, Ireland.

American Journal of Orthopedics (Belle Mead, N.J.)
|August 1, 1997
PubMed
Summary
This summary is machine-generated.

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Postoperative pyrexia after total knee replacement is common and usually not a sign of infection. Significant fever is linked to lower hematocrit and blood transfusions, not surgical factors.

Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Physiology

Background:

  • Postoperative pyrexia is a common occurrence following total knee arthroplasty.
  • The diagnostic value of septic screening in patients with pyrexia after knee replacement requires clarification.

Purpose of the Study:

  • To identify predictors of postoperative pyrexia after total knee replacement.
  • To evaluate the utility of septic screening in this patient population.

Main Methods:

  • Retrospective review of 90 patients (92 total knee replacements).
  • Definition of postoperative pyrexia: axillary temperature > 37°C for 5 days post-surgery.
  • Logistic regression analysis to identify predictors of significant fever (> 39°C).

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Main Results:

  • All patients experienced postoperative pyrexia; none developed infected arthroplasty at 2-year follow-up.
  • Significant fever risk doubled with each unit drop in hematocrit and increased fourfold per unit of blood transfused.
  • No association found between pyrexia, septic screening, and infection; urinary tract infections did not cause high fevers.

Conclusions:

  • Early postoperative pyrexia after total knee arthroplasty is a normal physiological response.
  • Hematocrit drop and blood transfusion are predictors of significant postoperative fever.
  • Routine septic screening for early postoperative pyrexia is not indicated without positive physical findings.