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Postoperative fever: differences between elective vs. traumatic hip, knee and shoulder arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

It is unclear whether there is a difference in the incidence of postoperative fever (POF) between hip, knee and shoulder arthroplasty. The influence of a trauma setting has not been investigated.

Methods

A retrospective review was performed on 675 joint replacement surgeries (hip, knee, shoulder arthroplasty) in an elective or trauma setting over a 2 year period (2016–2018). Patient demographics and perioperative/postoperative parameters were investigated. The fever curve was characterized. The results and costs of any fever-related diagnostic workup were reviewed.

Results

A total of 89 patients (13.2%) experienced a POF ≥ 38.0 °C, only 21 patients (3.1%) a POF ≥ 38.5 °C (of the latter: 4.6% of hip arthroplasties, 0.6% of knee arthroplasties, 0% of shoulder arthroplasties). There was a significantly greater risk (OR 3.88) for POF ≥ 38.5 °C in trauma total hip arthroplasty (THA) compared to elective THA (10.6 vs. 3.0%; p < 0.01). Differences in POF rate between the various joint areas were statistically insignificant when comparing only elective and trauma cases with each other, even though there was a trend for higher rates in hip surgery. Patients experiencing POF ≥ 38.5 °C were more often males (p < 0.01) and had an increased intraoperative blood loss (p = 0.03) and longer hospital stay (p < 0.01). There was only 1/89 POF patients developing an early periprosthetic joint infection. The cost of a positive fever workup (3/27 patients, 11.1%) leading to a new diagnosis and treatment was 2045 US$.

Conclusion

POF ≥ 38.5 °C was more frequent in traumatic THA compared to elective THA. A trend of difference between POF rates between the different joint areas was statistically insignificant after separating elective and traumatic cases. The risk of developing an early periprosthetic joint infection was not increased in POF. A fever-related diagnostic workup was rarely helpful in the absence of clinical symptoms.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland

    Stephan Radzanowski, Andreas Flury, Timo Tondelli, Naeder Helmy & Felix Regenfelder

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  1. Stephan Radzanowski
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  2. Andreas Flury
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  3. Timo Tondelli
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  4. Naeder Helmy
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  5. Felix Regenfelder
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis was performed largely by SR with the support of AF and TT. The first draft of the manuscript was written by SR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephan Radzanowski.

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Conflict of interest

Naeder Helmy receives royalties from Medacta International (Switzerland) and he is a medical advisor of Medacta International (Switzerland), Bayer AG, and Mathys (Switzerland). These affiliations are NOT relevant to the content of this research article, though. The other authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The local Human Investigation Committee (IRB) approved this study.

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Informed consent was obtained from all individual participants included in the study. Patients signed informed consent regarding publishing their data.

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Radzanowski, S., Flury, A., Tondelli, T. et al. Postoperative fever: differences between elective vs. traumatic hip, knee and shoulder arthroplasty. Arch Orthop Trauma Surg 143, 4077–4084 (2023). https://doi.org/10.1007/s00402-022-04716-7

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  • DOI: https://doi.org/10.1007/s00402-022-04716-7

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