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C-reactive protein course during the first 5 days after total knee arthroplasty cannot predict early prosthetic joint infection

Archives of Orthopaedic and Trauma Surgery volume 137, pages 1115–1119 (2017)Cite this article

Abstract

Introduction

Periprosthetic joint infection (PJI) is one of the most devastating major complications after total knee arthroplasty (TKA). The laboratory value C-reactive protein (CRP) is the inflammatory biomarker most suitable for detecting a potential postoperative (p.o.) early infection in orthopaedic surgery. However, on the basis of multiple receiver operating characteristic (ROC) analyses, CRP only has limited sensitivity and specificity. The objective of the present study was to test the hypothesis that, besides the absolute preoperative CRP value, also the absolute postoperative CRP value and its course over the first 5 days after TKA are valid indicators of periprosthetic early infection.

Materials and methods

A total of 1068 subjects who had been treated with a unilateral primary cemented total knee replacement due to primary osteoarthritis of the knee were included in the study. Retrospectively, for all patients, the preoperative CRP value, the p.o. CRP course and a history of the medical course, including any superficial surgical site infection (SSI) or deep PJI of the knee joint operated on, were recorded; further, any follow-up operations (septic revision) were documented. Using receiver operating characteristic (ROC) analysis, an optimum preoperative CRP cutoff value for the positive prediction of a PJI was determined.

Results

34 of 1068 patients developed an SSI or a PJI that had to be revised. After TKA implantation, the CRP value increased significantly and achieved its maximum between the second and third p.o. day. At no p.o. day was there a difference in CRP between patients who developed an SSI or a deep PJI and patients with a normal complication-free p.o. course. In contrast, the preoperative CRP value proved to be a reliable predictor for septic revision due to an SSI or a PJI: the ROC analysis showed the optimum preoperative CRP cutoff value for a positive prediction of PJI to be 5 mg/L.

Conclusion

The most important finding of the present study is that neither the absolute p.o. CRP value nor its course in the first 5 days after TKA is suitable for detecting an early infection. In contrast, an increased preoperative CRP value proved to be a valid predictor for septic revision due to an SSI or a PJI after TKA.

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Affiliations

  1. Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany

    Christoph Windisch, Steffen Brodt, Eric Roehner & Georg Matziolis

Authors
  1. Christoph Windisch
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  2. Steffen Brodt
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  3. Eric Roehner
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  4. Georg Matziolis
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Corresponding author

Correspondence to Christoph Windisch.

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Ethical approval

The study was approved by the ethics committee of the medical faculty at the Friedrich-Schiller University of Jena, Germany (Decision Number 4797-05/16).

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The authors declare that they have no conflict of interest.

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Windisch, C., Brodt, S., Roehner, E. et al. C-reactive protein course during the first 5 days after total knee arthroplasty cannot predict early prosthetic joint infection. Arch Orthop Trauma Surg 137, 1115–1119 (2017). https://doi.org/10.1007/s00402-017-2709-8

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  • DOI: https://doi.org/10.1007/s00402-017-2709-8

Keywords

  • Osteoarthritis
  • Periprosthetic joint infection (PJI)
  • C-reactive protein (CRP)
  • Total knee arthroplasty (TKA)