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Staged Revision for Knee Arthroplasty Infection: What Is the Role of Serologic Tests Before Reimplantation?

  • Symposium: Papers Presented at the 2008 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Erythrocyte sedimentation rate and C-reactive protein are common preoperative diagnostic markers for prosthetic joint infection but their prognostic role before reimplantation has yet to be defined. We therefore determined the prognostic value of erythrocyte sedimentation rate and C-reactive protein performed before second-stage reimplantation for the treatment of infected total knee arthroplasty (TKA). We studied 109 patients who had undergone two-stage revision TKA for sepsis from 1999 to 2006. Receiver operating characteristic curves were constructed to determine the discriminatory value of erythrocyte sedimentation rate and C-reactive protein before reimplantation in predicting persistent infection. Twenty-three of the 109 patients (21%) required revision surgery for recurrence of prosthetic joint infection. The receiver operating characteristic areas under the curve suggested erythrocyte sedimentation rate and C-reactive protein poorly predicted persistent infection after TKA reimplantation. Cutoff values could not be obtained because of the high variance. We reached similar conclusions regarding the change in erythrocyte sedimentation rate and C-reactive protein levels from time of resection. More accurate diagnostic tools are needed to support clinical judgment in monitoring infection progress and thus deciding whether to proceed with TKA reimplantation.

Level of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Rothman Institute of Orthopedics at Jefferson, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Elie Ghanem MD, Khalid Azzam MD, Mark Seeley MD, Ashish Joshi MD, MPH & Javad Parvizi MD, FRCS

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  1. Elie Ghanem MD
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  2. Khalid Azzam MD
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  3. Mark Seeley MD
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  4. Ashish Joshi MD, MPH
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  5. Javad Parvizi MD, FRCS
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Correspondence to Javad Parvizi MD, FRCS.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Ghanem, E., Azzam, K., Seeley, M. et al. Staged Revision for Knee Arthroplasty Infection: What Is the Role of Serologic Tests Before Reimplantation?. Clin Orthop Relat Res 467, 1699–1705 (2009). https://doi.org/10.1007/s11999-009-0742-9

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  • DOI: https://doi.org/10.1007/s11999-009-0742-9

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