C-reactive protein is not a screening tool for late periprosthetic joint infection

Journal of Orthopaedics and Traumatology - Tập 21 - Trang 1-5 - 2020
Bernd Fink1,2, Michael Schlumberger1, Julian Beyersdorff2, Philipp Schuster1,3
1Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Markgröningen, Germany
2Orthopaedic Department, University Hospital Hamburg-Eppendorf, Hamburg, Germany
3Department of Orthopedics and Traumatology, Clinic Nuremberg,, Paracelsus Medical Private University, Nuremberg, Germany

Tóm tắt

Preoperative diagnosis of periprosthetic joint infection (PJI) is important because of the therapeutic consequences. The aim of the present study is to investigate whether the serum C-reactive protein (CRP) level can be used as a screening tool for late PJI. A cohort of 390 patients with revision surgery of total hip prostheses (200) or total knee prostheses (190) was assessed for late PJI by determining CRP serum level and performing preoperative aspiration with cultivation and intraoperative tissue analyses with cultivation and histologic examination, using the Musculoskeletal Infection Society (MSIS) and International Consensus Meeting (ICM) criteria. A total of 180 joints were rated as PJI (prevalence 46%). Of these, 42.8% (77) showed a CRP level below 10 mg/L and 28.3% (51) showed a normal CRP level of less than 5 mg/L. The 76.9% of the cases with slow-growing bacteria showed a CRP level below 10 mg/L, and 61.5% showed a normal CRP level. Serum CRP level should not be used as a screening tool to rule out late PJI. Level 2 (diagnostic study).

Tài liệu tham khảo

Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715 Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA (2017) Current epidemiology of revision total knee arthroplasty in the United States. J Arthroplasty 32(9):2663–2668 Saleh KJ, Rand JA, McQueen A (2003) Current status of revision total knee arthroplasty: how do we assess results? J Bone Joint Surg Am 85(Suppl. 1):18–20 Hanssen AD (2002) Managing the infected knee: as good as it gets. J Arthroplasty 17(4 Suppl 1):98–101 Della Valle CJ, Zuckermann JD, Di Cesare PE (2004) Periprosthetic sepsis. Clin Orthop Rel Res 420:26–31 Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B:1450–1452 Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33:1309–1314 Saleh A, George J, Faour M, Klika AK, Higuera CA (2018) Serum biomarkers in periprosthetic joint infections. Bone Joint Res 7:85–93 Alijanipour P, Bakhshi H, Parvizi J (2013) Diagnosis of periprosthetic joint infection. The threshold for serological markers. Clin Orthop Relat Res 471:3186–3195 Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, CG, Zalavras (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994 Parvizi J, Della Valle, CJ (2010) AAOS clinical practice guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 18:771–772 Fink B, Makowiak C, Fuerst M, Berger I, Schäfer P, Frommelt L (2008) The value of synovial biopsy and joint aspiration in the diagnostic of late periprosthetic infection of total knee arthroplasties. J Bone Joint Surg Br 90-B:874–878 Fink B, Gebhard A, Fuerst M, Berger I, Schäfer P (2013) High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip. Clin Orthop Relat Res 471:956–964 Pérez-Prieto D, Portillo ME, Puig-Verdié L, Alier A, Martínez S, Sorlí L, Horcajada JP, Monllau JC (2017) C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop 41:1315–1319 Akgün D, Müller M, Perka C, Winkler T (2018) The serum level of C-reactive protein alone cannot be used for the diagnosis of prosthetic joint infections, especially in those caused by organisms of low virulence. Bone Joint J 100-B:1482–1486 Kheir MM, Tan TL, Foltz C, Parvizi J (2018) Routine diagnostic test for periprosthetic joint infection demonstrate a high false-negative rate and are influenced by the infection organism. J Bone Joint Surg Am 100-A:2057–2065 Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 47:1403–1409 Virolainen P, Lahteenmaki H, Hiltunen A, Sipola E, Meurman O, Nelimarkka O (2002) The reliability of diagnosis of infection during revision arthroplasties. Scand J Surg 91:178–181 Pandey R, Drakouilakis E, Athanasou NA (1999) An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues. J Clin Pathol 52:118–123 Heinecke A, Hultsch E, Repges R (eds) (1992) Medizinische Biometrie. Springer, Berlin Fink B, Steurer M, Hofäcker S, Schäfer P, Sandow D, Schuster P, Oremek D (2018) Preoperative PCR analysis of synovial fluid has limited value for the diagnosis of periprosthetic joint infections of total knee arthroplasties. Arch Orthop Trauma Surg 138:871–878 Fernández-Sampedro M, Farinas-Alverez C, Garces-Zarzelejo C, Alonso-Aguirre MA, Salas-Venero C, Martinez-Martinez L (2017) Accuracy of different diagnostic tests for early, delayed and late prosthetic joint infection. BMC Infect Dis 17:592