Aim To evaluate the sensitivity and specificity of serum C-reactive protein (CRP) in early and late total knee arthroplasty (TKA) infections. Methods Blood tests to determine CRP levels (cut-off 10 mg/L) were conducted before surgery, at 1st day, 7th day and 15th day after surgery and at 1, 3, 6,12, 24 and 36 months. Patients had routine follow-up visits and radiological evaluations at 14 days and at 1, 3, 6, 12, 24 and 36 months. Infections were recorded and classified according to Widmer classification. The χ2 test or Fisher (in subgroups smaller than 10 patients) exact test was used to compare categorical variables. The statistical significance was set at p < 0.05. Results A total of 19 infections were diagnosed during the followup. According to Widmer, five were classified as early post-operative and 14 as late chronic. All patients with early infections had suspected symptoms such as fever, swelling and pain. During the first month, 59 patients who had high CRP level but negative microbiological culture were considered as false positive representing a CRP sensitivity of 80% and a specificity of 67.6%. Fourteen patients had late chronic infection. Conclusion This study suggests that a synovial fluid aspiration should be performed in patients with persistent inflammation symptoms with or without radiographic signs of loosening. Moreover, it recommends the use of different serum and synovial tests for periprosthetic joint infection (PJI) diagnosis.
Pérez-Prieto D, Portillo ME, Puig-Verdié L, Alier A, Martinèz S, Sorli L, et al. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Vol. 41, Int Orthop. 2017. p. 1315–9.
2.
Zimmerli W, Trampuz A, Ochsner PE. Prostheticjoint infections. Vol. 351, N Engl J Med. 2004. p. 1645–54.
3.
Widmer AF. New developments in diagnosis and treatment of infection in orthopedic implants. Vol. 33, Clin Infect Dis. 2001.
4.
Gehrke T, Alijanipour P, Parvizi J. The management of an infected total knee arthroplasty. Vols. 97-B (10 Suppl A):20-9, Bone Joint J. 2015.
5.
Myckatyn TM, Cohen J, Chole RA. Clarification of the definition of a “Biofilm. Vol. 137, Plast Reconstr Surg. 2016.
6.
McArthur BA, Abdel MP, Taunton MJ, Osmon DR, Hanssen AD. Seronegative infections in hip and knee arthroplasty: periprosthetic infections with normal erythrocyte sedimentation rate and C-reactive protein level. Bone Joint J. 2015.
7.
Piper KE, Fernandez-Sampedro M, Steckelberg KE, Mandrekar JN, Karau MJ, Steckelberg JM, et al. C- reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. Vol. 20210, PLoS One. p. 5 9358.
8.
Kheir MM, Tan TL, Shohat N, Foltz C, Parvizi J. Routine diagnostic tests for periprosthetic joint infection demonstate a high false-negative rate and are influenced by the infecting organism. Vol. 100, J Bone Joint Surg Am. 2018. p. 2057–65.
9.
Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: an evidence- based and validated criteria. Vol. 33, J Arthroplasty. 2018. p. 1309–14.
10.
Fink B, Schlumberger M, J S, P. C-reactive protein is not a screening tool for late periprosthetic joint infections. Vol. 21, J Orthop Traumatol. 2021.
11.
Owens WD, Felts JA, EL S. Asa physical status classifications: a study of consistency of ratings. Vol. 49, Anesthesiology. 1978. p. 239–43.
12.
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Valle CJD, et al. Charalampos G Zalavras New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Vol. 469, Clin Orthop Relat Res. 2011. p. 2992–4.
13.
C DV, J P, TW B. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and the knee. Vol. 93, J Bone Joint Surg Am. 2011. p. 1355–7.
14.
Baré J, MacDonald SJ, Bourne RB. Preoperative evaluations in revision total knee arthroplasty. Vol. 446, Clin Orthop Relat Res. 2006. p. 40–4.
15.
Austin MS, Ghanem E, Joshi A, Lindsay A, Parvizi J. A simple, cost-effective screening protocol to rule out periprosthetic infection. Vol. 23, J Arthroplasty. 2008. p. 65–8.
16.
Johnson AJ, Zywiel MG, Stroh A, Marker DR, Mont MA. Serological markers can lead to a false negative diagnoses of periprosthetic infections following total knee arthroplasty. Vol. 35, Int Orthop. 2011. p. 1621–6.
17.
Deimengian CA, Citrano PA, Gulati S, Kazarian ER, Stave JW, Kardos KW. The C-reactive protein may not detect infections caused by less-virulent organism. Vol. 31, J Arthroplasty. 2016. p. 152–5.
18.
Parvizi J, Jacovides C, Adeli B, Jung KA, Hozack WJ. Coventry award: synovial C-reactive protein: a prospective evaluation of a molecular marker for periprosthetic knee joint Clin Orthop Relat Res. Vol. 470. 2012. p. 54–60.
19.
Tetreault MW, Wetters NG, Moric M, Gross CE, Della Valle CJ. Is synovial C-reactive protein a useful marker for periprosthetic joint infection? Vol. 472, Clin Orth op Relat Res. 2014. p. 3997–4003.
20.
Kheir MM, Tan TL, Shohat N, Foltz C, Parvizi J. Routine diagnostic tests for periprosthetic joint infection demonstrate a high false-negative rate and are influenced by the infecting organism. Vol. 100, J Bone joint Surg Am. 2018. p. 2057–65.
21.
Shahi A, Parvizi J, Kazarian GS, Higuera C, Frangiamore S, Bingham J, et al. The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration. Vol. 474, Clin Orthop Relat Res. 2016. p. 1610–5.
22.
Shahi A, Kheir MM, Tarabichi M, Hosseinzadeh HRS, Tan TL. Parvizi J Serum D-Dimer test is Promising for the diagnosis of periprosthetic joint infection and timing of reimplantation. Vol. 99, J Bone Joint Surg Am. 2017. p. 1419–27.
23.
Koh IJ, Cho WS, Choi NY, Parvizi J, Kim TK. Korea Knee Research Group How accurate are orthopedic surgeons in diagnosing periprosthetic joint infection after total knee arthroplasty?: A multicenter study. Vol. 22, Knee. 2014. p. 180–5.
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