C-Reactive Protein (CRP) Levels After Elective Orthopedic Surgery

Larsson, Sune; Thelander, Ulf; Friberg, Sven

doi:10.1097/00003086-199202000-00035

Cited by 208 publications

(210 citation statements)

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“…This finding is additive to the existing evidence and may reflect the normal physiologic difference of inflammatory reaction to arthroplasty that is more intense in knees than in hips [7,21,24,40]. The exact mechanism remains unknown, though Larsson et al [21] suggested TKA is more traumatic to bone and marrow tissue, which has a higher content of inflammatory cells. Although ESR values were higher in late-chronic knees than in hips, thresholds were calculated at approximately similar points (48.5 and 46.5 mm/hour for hips and knees, respectively).…”

Section: Discussionmentioning

confidence: 58%

“…However, pathophysiologic differences in ESR and CRP should also be considered. Two studies [21,26] have shown, after arthroplasty, ESR increases more slowly and less prominently than CRP. It also decreases more slowly, reacts less consistently, and may have more frequent atypical patterns than CRP.…”

Section: Discussionmentioning

confidence: 99%

“…Even after uncomplicated arthroplasty, ESR and CRP remain elevated for 3 to 8 weeks [7,14,21,26]. Thus, time after index arthroplasty can have a confounding influence on ESR and CRP values.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Alijanipour

Bakhshi

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

117

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Background Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily. Questions/purposes Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis. Methods We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds. Results ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively. Conclusions The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds. Level of Evidence Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Alijanipour

Bakhshi

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

117

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“…Furthermore, the level of these serum markers is affected by age, sex, and medical comorbidities of the patient. It has also been reported these markers can be elevated for approximately 30 to 60 days in the immediate postoperative period [3,9].…”

Section: Serum Testsmentioning

confidence: 86%

New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

Parvızı

Zmistowski

Berbari

et al. 2011

Clinical Orthopaedics &Amp; Related Research

1,616

1,093

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“…Study inclusion criteria were (1) patients who underwent TKA; and (2) [6,14]. Reviewing more than 1100 infected patients in the database of the three participating centers, 182 patients were identified with a documented note about their antibiotic administration status.…”

Section: Methodsmentioning

confidence: 99%

Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection

Shahi

Deirmengian

Higuera

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI. Questions/purposes The purpose of this study was to investigate the correlation of antibiotic administration with (1) fluctuations in the synovial fluid and serology laboratory values; and (2) sensitivity of the diagnostic tests in patients with late PJI (per Musculoskeletal Infection Society [MSIS] criteria). Methods Synovial white blood cell (WBC) count, polymorphonuclear neutrophil (PMN) percentage, and serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as culture results were investigated in 161 patients undergoing total knee arthroplasty with late PJI diagnosed with the MSIS criteria. Depending on whether presampling antibiotics were used, patients were divided in two groups (53 [33%] patients were on antibiotics). The median laboratory values and the false-negative rates were compared between the two groups.

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C-Reactive Protein (CRP) Levels After Elective Orthopedic Surgery

Cited by 208 publications

References 0 publications

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection

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