Serological markers can lead to false negative diagnoses of periprosthetic infections following total knee arthroplasty

Periprosthetic infections following total knee arthroplasty (TKA) are diagnostically challenging. We evaluated the sensitivity and specificity of ESR and CRP, false negative rates, whether false negative rates differed between early post-operative and late infections, and the predictive ability of ESR and CRP to differentiate infected patients. Between 2000 and 2007, a prospectively collected database was reviewed to identify patients with suspected periprosthetic infections, and who had ESR and CRP laboratory values. One hundred and thirteen patients were identified. False negative rates were calculated. Finally, receiver operating characteristic curves were used to determine the predictive ability of ESR and CRP to differentiate infected from non-infected patients. CRP had a sensitivity of 95% and specificity of 20%. ESR had a sensitivity of 91% and a specificity of 33%. The false negative rate was 9.2% for ESR, 5.3% for CRP, and 11.1% for combined ESR and CRP. False negative rates were higher for early post-operative infections. Although ESR and CRP can be excellent adjunctive diagnostic tools, we emphasise that because some patients may not mount a sufficient immune response, the entire clinical picture must be evaluated, and periprosthetic infection should not be ruled out on the basis of ESR and CRP results alone.     

Alteration of body temperature, erythrocyte sedimentation rate, and C-reactive protein after reamed intramedullary nailing: a prospective study

OBJECTIVES: This study was designed to confirm the clinical observation that patients undergoing reamed intramedullary nailing develop a high temperature in the early postoperative period and to further investigate this reaction by studying the alteration of biologic markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), during the early postoperative period. DESIGN: Body temperature, ESR, and CRP were monitored on admission, preoperatively, and postoperatively (1st, 3rd, and 10th days) in 30 consecutive patients who sustained isolated, closed femoral, or tibial diaphyseal fractures and were treated with reamed intramedullary nailing (study group). The same biologic parameters were monitored in 35 consecutive patients who sustained isolated, closed, intertrochanteric fractures of the femur at the same period of time and were treated with a Dynamic Hip Screw(R) (control group). Polytrauma patients or patients with pathologic problems or complications that could influence the results were excluded from the study. RESULTS: Body temperature, ESR, and CRP rise significantly (P < 0.0001) after reamed intramedullary nailing. CONCLUSIONS: Reamed intramedullary nailing causes significant inflammatory reaction that warrants further investigation. Knowledge that biologic markers are altered after reamed intramedullary nailing could help toward better postoperative management and undisturbed commencement of a physiotherapy program, and also toward better assessment and diagnosis of early postoperative complications, such as infection.     

A simple, cost-effective screening protocol to rule out periprosthetic infection

The differential diagnosis of pain after total knee arthroplasty includes infection. Effective screening tools should have high sensitivity and are cost-effective. We evaluated 296 patients who underwent total knee revision at our institution. One hundred sixteen patients (39%) were classified as infected and 180 patients (61%) were considered noninfected. The mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the infected patients were 85 mm/h and 110 mg/L, respectively. The mean ESR and CRP of the noninfected patients were 22 mm/h and 7 mg/L, respectively. Five patients (4%) in the infected group had both normal ESR and CRP. Infection was suspected in all 5 patients, and an organism was cultured in 4 of the 5 cases. Erythrocyte sedimentation rate and CRP, when used in combination, serve as a useful screening tool in patients with a painful total knee arthroplasty.     

在腰椎后路内固定术后早期发热患者中监测4种血清感染指标水平的临床意义

目的:评价腰椎内固定术后发热患者血清PCT、CRP、ESR水平,以及WBC计数在诊断患者是否合并感染中的作用。方法:对2012年1月至2014年1月间在脊柱外科接受腰椎后路内固定术治疗并在术后早期(术后10 d内)出现发热症状的58例患者进行回顾性分析。根据细菌学培养结果将58例患者分为发热并感染组(A组)和发热非感染组(B组),其中A组26例,B组32例。收集临床数据,比较两组间血清PCT、CRP、ESR,以及WBC计数的差异。根据受试者工作特征(ROC)曲线,分析上述指标在诊断术后早期发热患者是否合并感染中的作用。结果:A组PCT、CRP、ESR高于B组(P<0.05),但是B组CRP、ESR仍高于正常范围。同时在A组中,PCT在鉴别感染类型方面要优于CRP和ESR。各指标ROC曲线分析示,PCT曲线下面积最大,CI 95%为0.81~0.98,WBC计数对应的ROC则差异无统计学意义。对应各指标的截断点,CRP特异度最高为90.27%,ESR的灵敏度最高为88.50%。结论:对于腰椎后路内固定术后早期发热患者应予以足够的重视,合理选取监测指标对于早期诊断、早期预防感染有良好的参考价值。其中PCT受手术影响较小,在鉴别感染类型方面有一定的参考价值,CRP和ESR可作为初筛检测指标,WBC计数意义有限。     

Early catheter removal 3 days after radical retropubic prostatectomy

AIM: We investigated the feasibility and safety of the early removal of urethral catheters 3 days after radical retropubic prostatectomy. METHODS: Seventy consecutive patients underwent radical retropubic prostatectomy with the intent of early catheter removal on postoperative day (POD) 3. Catheter removal was based on postoperative cystograms performed on POD 2. Patients were analyzed using a validated prostate cancer specific questionnaire (University of California, Los Angeles Prostate Cancer Symptom Index) to determine quality of life outcomes. Multiple logistic regression analysis was also used to evaluate if any of the preoperative or intraoperative parameters were able to predict the success of early catheter removal after radical retropubic prostatectomy. RESULTS: The catheter was removed on POD 3 in 67 of 70 patients (97%) excluding three patients with moderate or severe extravasation on postoperative cystograms. Of the 67 patients, 53 (76%) were successful in early catheter removal, but the remaining 14 (24%) patients experienced urinary retention within 48 h and were treated with simple catheter replacement for 1 or 2 days. Two patients developed anastomotic strictures 3 and 4 months postoperatively, which were managed by dilation alone. Multiple logistic regression analysis showed that no leak during an intraoperative leak test was the only independent predictor of success for early catheter removal (P = 0.0069; odds ratio, 6.667; 95% confidence interval, 1.682-26.428). CONCLUSION: The present study revealed that early catheter removal 3 days after radical retropubic prostatectomy is feasible in patients who show a negative intraoperative leak test. Postoperative monitoring of more patients is needed to determine if the early catheter removal is widely applicable.     

Lumbar disc surgery and variations in C-reactive protein,erythrocyte sedimentation rate and the complement split product C 3 d

Summary Lumbar disc surgery was performed in fifty consecutive patients and variation in erythrocyte sedimentation rate (ESR), complement C 3 d, and C-reactive protein (CRP) levels before and after surgery were recorded. Preoperative values were within normal limits in all patients. Postoperatively, CRP increased immediately, with a maximum of 28.5 mg/l on the 2nd day and were normalized within 6 days. The maximum ESR elevation occurred after the 6th day and was followed by a slow decrease. After 12 weeks some patients still had an elevated ESR. Plasma C 3 varied pari passu with the ESR. Uncomplicated recovery after lumbar disc surgery seems to be indicated by a normalization of CRP, regardless of ESR values. Therefore, ESR may not be so useful as an indicator of disc space inflammation as previously accepted.     

循PCD引流管路径微小切口联合经皮肾镜治疗重症急性胰腺炎感染性坏死

目的:探讨循PCD引流管路径作微小切口联合经皮肾镜清除胰腺坏死组织的方法治疗重症急性胰腺炎(SAP)感染性坏死的临床效果。方法:23例经PCD引流的感染期SAP患者出现引流不畅等治疗效果不佳后,循PCD引流管路径作一约2 cm微小切口,用取石钳取出浅层部分胰腺坏死组织,深在部分坏死组织联合经皮肾镜直视下用网篮取出,在残腔的高、低位分别置入冲洗管及双套管,从腹壁相应较簿的位置戳孔引出并固定,原PCD引流管管口予以关闭。术后用生理盐水自冲洗管冲洗脓腔,双套管负压状态下作持续负压吸引将残余坏死组织逐步清除干净。监测记录患者术前、术后引流量(出入量差)、体温、白细胞(WBC)数、降钙素原(PCT)、C-反应蛋白(CRP),术后1个月复查腹部CT了解胰腺周围坏死组织残余情况。结果:23例感染期SAP经上述方法处理后,感染中毒症状均改善,术后30 d内引流量均较术前明显增多(均P0.05),感染指标(体温、WBC数、PCT、CRP)均在术后不同时间点较术前明显下降(均P0.05),术后1个月左右复查CT显示胰周坏死组及积液基本消失,其中5例术后2周出现冲洗管堵塞需换管继续冲洗引流,所有患者未出现腹腔出血、肠漏、穿孔等并发症,无需行二次微创手术干预或开腹手术处理,患者最终均痊愈出院。结论:循PCD引流管路径作微小切口联合经皮肾镜清除胰腺坏死组织的方法在治疗SAP感染性坏死有较好的临床效果。     

The diagnostic value of C-reactive protein in infected total hip arthroplasties

In 50 patients with non-infected total hip arthroplasties (THA), 233 C-reactive protein (CRP) values were obtained over a three-year period. Six of these 50 patients occasionally had CRP values of over 20 mg/l. The erythrocyte sedimentation rate (ESR) and CRP concentration were measured in 23 patients with deep infections of THA before revision. In 11 patients the infections were caused by coagulase-negative staphylococci. CRP exceeded 20 mg/l in 18 patients and the ESR was more than 30 mm/hr in 14. In only one infected patient were both CRP and ESR below these levels. All of 33 patients with non-septic loosening had CRP less than 20 mg/l and ESR less than 30 mm/hr before revision. C-reactive protein seems to be a valuable supplement to the ESR in the monitoring of infection after THA.     

Procalcitonin for the early prediction of renal parenchymal involvement in children with UTI: preliminary results

In order to establish the most reliable marker for distinguishing urinary tract infections (UTI) with and without renal parenchymal involvement (RPI), we recorded the clinical features and admission leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum procalcitonin (PCT) in 57 children (including 43 girls) aged 2–108 months admitted with a first episode of UTI. RPI was evaluated by Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. To establish cut-off points for ESR, CRP, and PCT, we used receiver operating characteristics curves and compared the area under the curve for ESR, CRP, and PCT. Twenty-seven children were diagnosed as having RPI based on positive renal scintigraphy. A body temperature of >38°C, a history of diarrhea, and poor oral intake were more common in patients with RPI. ESR, CRP, and PCT, but not leukocyte count, were significantly higher in patients with RPI (P < 0.001). PCT was more sensitive and specific for the diagnosis of upper versus lower UTI than ESR and CRP. Using a cut-off value of 0.85 ng/ml, PCT had the best performance, with sensitivity, specificity, and positive and negative predictive values of 89%, 97%, 96%, and 91% respectively. Serum PCT is a better marker than ESR, CRP, and leukocyte count for the early prediction of RPI in children with a first episode of UTI.     

Serial estimation of C-reactive protein following cardiac surgery

Serial estimation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and total leucocyte count (TLC) was done in seventy eight consecutive patients undergoing cardiac surgery between 1st June and 18th July 1985 at our institution. In non-infected patients the CRP level reached a peak on 3rd day and declined to near pre operative level towards the end of 2nd week. But CRP level in infected patients continued to remain elevated till infection abated. There was statistically significant difference in CRP value between infected and non-infected patients (p<0.01, t test) from the sixth post operative day onwards. The rise in concentration of CRP from earlier value or sustained high concentration or a spike suggests infection. CRP was more reliable than ESR and TLC.     

血清感染指标对颈后路单开门椎管扩大成形术后早期感染的诊断价值

目的：探讨白细胞计数（WBC）、C-反应蛋白（CRP）、血清降钙素原（PCT）及红细胞沉降率（ESR）水平对颈后路单开门椎管扩大成形术后早期感染的诊断价值,及时发现、预防和治疗术后感染患者。方法：回顾性分析2010年1月至2019年4月颈后路单开门椎管扩大成形术后早期发热的患者120例;按照患者伤口渗出液细菌学培养的结果将其分为感染组（53例）和未感染组（67例）,感染组中,男32例,女21例,年龄48～63（52.28±6.36）岁;未感染组中,男37例,女30例,年龄46～62（51.63±5.82）岁。并根据感染组患者术后感染类型将其分为深部手术部位感染组（30例）和浅表手术部位感染组（23例）,深部手术部位感染组中,男19例,女11例,年龄50～63（53.16±5.62）岁;浅表手术部位感染组中,男13例,女10例,年龄48～61（52.15±5.68）岁。比较组间患者及组内患者手术前后WBC计数、CRP、PCT及ESR血清感染指标。收集纳入的120例患者血清感染学指标数据并根据血清感染指标诊断感染的灵敏度及特异性,以1-特异性为横坐标,灵敏度为纵坐标绘制受试者工作特征（ROC）曲线对WBC计数、CRP、PCT以及ESR感染指标进行早期感染诊断的准确性评估。结果：术前：感染组和未感染组患者的WBC计数、CRP、PCT、ESR血清感染指标水平相近（P>0.05）;术后：感染组患者的WBC计数、CRP、PCT、ESR感染指标较未感染组高（P<0.05）。在术后感染的患者中,WBC计数、CRP、PCT以及ESR血清感染指标水平在不同术后感染类型的患者中存在差异（P<0.05）。未感染组患者的WBC计数、CRP、PCT以及ESR血清感染指标总体呈现出先升后降的趋势。WBC计数感染指标的受试者曲线下面积（AUC）为0.637（P<0.05）;CRP感染指标的AUC为0.792（P<0.05）;PCT感染指标的AUC为0.774（P<0.05）;ESR感染指标的AUC为0.783（P<0.05）。结论：WBC计数、CRP、PCT、ESR血清感染指标可用于颈后路单开门椎管扩大成形术后早期感染的诊断,除此之外,上述4种感染指标变化的综合分析可用于不同术后感染类型的鉴别。WBC计数指标对于早期感染诊断的准确性较低,CRP、PCT以及ESR指标对于早期感染诊断的准确性较好。总体上来说,CRP、PCT以及ESR血清感染指标对于颈后路单开门椎管扩大成形术后早期感染的诊断来说具有重要的临床意义,有助于临床工作者尽早发现术后早期感染以利于随后的相应治疗。     

C-reactive protein (CRP) levels after elective orthopedic surgery.

The levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined by serial measurements after four types of uncomplicated elective orthopedic surgery. The type of operations chosen for this study were total hip arthroplasty (primary, n = 109; and revisions caused by aseptic loosening, n = 9), unicondylar knee arthroplasty (n = 39), and lumbar microdiskectomy (n = 36). In all patients, CRP levels increased after surgery, reaching peak levels on the third day after hip arthroplasties (primary, 116 +/- 43 mg/l; revisions, 136 +/- 58 mg/l) and on the second day after knee arthroplasties (140 +/- 46 mg/l) and lumbar microdiskectomy (48 +/- 27 mg/l). C-reactive protein levels usually dropped to normal (less than 10 mg/l) within 21 days after surgery. No correlations were found between CRP response and the type of anesthesia, amount of bleeding, transfusion, operation time, administered drugs, age, or gender. Erythrocyte sedimentation rate increased to peak levels about five days after surgery, followed by a slow and irregular decrease. Still, 42 days after uncomplicated operations ESR often remained elevated. In conclusion, the level of CRP must be considered a better diagnostic aid for the early detection of postoperative infections than ESR. It can be assumed that the rapid decline in CRP after uncomplicated orthopedic surgery will be interrupted by a second rise or by a persisting elevated level if infectious complications occur.     

The C-reactive protein for detection of early infections after lumbar microdiscectomy

Summary The tendency for short hospitalization after lumbar microdiscectomy implies the need for early confirmation or disproval of serious postoperative infections such as spondylodiscitis or deep wound infections. The C-reactive protein (CRP) is a well-known screening parameter for monitoring postoperative infectious complications in other fields. Our objective was to establish the diagnostic significance of CRP-in comparison with ESR and WBC-for monitoring infectious complications after lumbar microdiscectomy. Over a 15 months period we studied prospectively a homogeneous group of N = 400 patients with lumbar disc herniations who were operated on a single level for the first time. CRP, ESR and WBC values were determined in all patients pre-operatively, and on postoperative days 1 and 5. Clinical and laboratory findings were correlated and the diagnostic significance of CRP, ESR and WBC calcualted. N = 385 (96%) patients had an uneventful postoperative course. N = 15 (4%) patients developed infectious complications, of which N = 6 (1.5%) were unrelated and N = 9 (2.5%) related to surgery. Evaluation of the laboratory values showed: The CRP baseline is a very individual value of no prognostic relevance. A high postaggression peak is typical and essential as a reference value for only the future time course will disclose any infection. We found 0% false negative and 4% false positive results on day 5. The sensitivity for serial CRP testing was calculated as 100% and specificity as 95.8%. ESR (sensitivity: 78.1%/specificity: 38.1%) and WBC (sensitivity: 21.4%/specificity: 76.8%) both failed to reach such distinct diagnostic significance on day 5. The C-reactive protein has thus proved to be a reliable, simple and economical screening test for infectious complications after lumbar microdiscectomy, superior to classical laboratory parameters.     

Urethral catheter removal 3 days after radical retropubic prostatectomy is feasible and desirable

The purpose of this work was to assess the feasibility of urethral catheter removal 3 days after radical retropubic prostatectomy (RRP). Twenty-two patients who underwent RRP with a watertight eight-suture vesicourethral anastomosis had their urethral catheter removed usually on postoperative day (POD) 3. The average day of urethral catheter removal was POD 3.2. At 3 months, 56% of patients required no or one protective pad to stay dry and 68.4% of patients 'never leaked' or 'leaked occasionally'. Following RRP, the urethral catheter can be removed as early as POD 3 if the intraoperative anastomosis is watertight without compromising urinary continence.     

The role of procalcitonin as a marker of diabetic foot ulcer infection

Foot ulcers are frequent in diabetic patients and are responsible for 85% of amputations, especially in the presence of infection. The diagnosis of diabetic foot ulcer infection is essentially based on clinical evaluation, but laboratory parameters such as erythrocyte sedimentation rate (ESR), white blood count (WBC), C‐reactive protein (CRP) and, more recently, procalcitonin (PCT) could aid the diagnosis, especially when clinical signs are misleading. Fifteen diabetic patients with infected foot ulcers were admitted to our department and were compared with an additional group of patients with non‐infected diabetic foot ulcers (NIDFUs). Blood samples were collected from all patients in order to evaluate laboratory markers. In the current study, the diagnostic accuracy of PCT serum levels was evaluated in comparison with other inflammatory markers such as CRP, ESR and WBC as an indicator to make the distinction between infected diabetic foot ulcers (IDFUs) and NIDFUs. CRP, WBC, ESR and especially PCT measurements represent effective biomarkers in the diagnosis of foot infections in diabetic patients particularly when clinical signs are misleading.     

一期翻修术治疗全膝关节置换术后感染

目的 报告全膝关节置换(total knee arthroplasty,TKA)术后感染一期翻修术的方法,分析其近期随访疗效.方法 2005年4月至2009年12月施行TKA术后感染一期翻修术22例,其中资料完整的随访6个月以上的患者16例,男5例,女11例;年龄49～75岁,平均65岁.均明确诊断为单侧TKA术后关节腔内感染.慢性感染(Ⅲ型)14例,迟发血源性感染(Ⅳ型)2例.术前美国膝关节协会评分(Knee Society Score,KSS)的功能评分平均为(37.25±16.23)分.翻修距初次手术时间为2～73个月,平均23.9个月.术中彻底清除肉芽坏死组织及瘢痕,用碘伏浸泡伤口,脉冲冲洗.14例骨缺损严重者采用带延长柄髁限制型假体,2例采用表面假体,抗生素骨水泥固定.结果 随访6～59个月,平均25个月.1例手术失败,分析原因可能与清创不彻底有关,8个月后行二期再翻修.1例于术后9个月出现局部疼痛,红细胞沉降率和C反应蛋白增高,经抗生素治疗1个月后疼痛消失,实验室检查恢复正常.其余14例在随访期间均无感染复发或再感染.末次随访时KSS功能评分平均(85.88±12.85)分,患者满意率87.5%(KSS功能评分75分以上,14/16).结论 对TKA术后感染患者行一期翻修术,经术中彻底清创,牢固固定假体及正确使用抗生素,术后平均2年的随访疗效良好,具有治疗周期短、费用低的特点,患者满意度高.但其中长期结果还需进一步随访观察.

Abstract：

Objective To evaluate the short term clinical results of single-stage revision for infected total knee arthroplasty (TKA). Methods Twenty-two unilateral infected TKA were revised through onestage implant exchange using antibiotics loaded cement from April 2005 to December 2009. Sixteen patients who were followed up at least 6 months were included in this study. There were 5 male and 11 female with the mean age of 65 years old (range 49 to 75) in this group. Fourteen patients were diagnosed as late chronic infection (＞ 4 weeks) and 2 cases as hematogenous spread delayed infection. The average Knee Society Score (KSS) functional score was 37.25±16.23. The average time from primary arthroplasty to revision was 23.9months (range 2 to 73). During the operation, the inflammatory, necrotic and scar tissue must be removed radically. Constrained condyle knee (CCK) prosthesis with stem were used in 14 cases with severe bone loss and primary prosthesis were used in 2 cases. All cases were fixed with antibiotics-loaded cement. Results All cases were followed up for the average 25 months (range 6 to 59 months), Infection recurred in one case who had to undergo another two-stage revision. One case who complained of local knee pain with elevated ESR and CRP 9 months postoperatively responded to appropriate one-month course of antibiotic therapy. The average KSS functional score was 85.88±12.85 and the satisfactory rate was 87.5% at last follow-up. Conclusion Good outcomes can be reached by radical debridement, correct choice of implant, careful perioperative management, and effective antibiotics in single-stage revision for infected TKA.     

The role of C-reactive protein after surgery for obesity and metabolic disorders

BackgroundC-reactive protein (CRP) rise might be different in patients with obesity due to chronic inflammation.ObjectivesThe aim was to analyze postoperative CRP rise and its role as an early prognostic marker of infectious complications.SettingCenter of maximum care in Germany.MethodsPatients who underwent laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, or laparoscopic one-anastomosis gastric bypass as primary treatment for severe obesity were included. Serum CRP and leukocyte count were measured preoperatively, on postoperative days (POD) 1 and 4 and were analyzed regarding sex, body mass index, waist circumference, obesity-associated diseases, laboratory measurements (glycosylated hemoglobin, triglycerides, cholesterol), surgical procedure, infectious complications, and infectious with anastomotic leakage.ResultsFour hundred seventy-one patients underwent surgery. Postoperative CRP rise was similar across sexes but lower in the super-super obese group (P < .05) and higher in the gastric bypass groups (P < .05). Linear regression model showed, that the higher preoperative value of waist circumference, the higher the preoperative CRP (beta value: .159, P = .006) and the lower the postoperative CRP rise on POD1 (beta value: −.171, P = .004) and 4 (beta value: −.170, P = .003). Only in the laparoscopic one-anastomosis gastric bypass group did a higher glycosylated hemoglobin predict a higher postoperative CRP rise (POD1: beta value: .434, P = .012; POD4: beta value: .513, P = .006). Fourteen patients (3%) developed infections, 7 of whom (1.5%) had anastomotic leakage. Leukocyte count was no predictor of infectious complications. The cut-off for CRP was 80.5 mg/L (POD1) and 164 mg/L (POD4), with 57.1% and 85.7% sensitivity and 97.9% and 99.6% specificity for anastomotic leakage.ConclusionStandard postoperative CRP rises less in patients with higher waist circumference and super-super obesity, but more after gastric bypass procedures. CRP but not leukocyte count predicts early anastomotic healing after obesity surgery. These findings should be considered when interpreting CRP values in the routine clinical setting.     

Laparoscopic gastrectomy for early gastric cancer targeting as a less invasive procedure

Background Since only a few extensive reports are available on the less invasive nature of laparoscopic gastrectomy, we compared postoperative changes over time in vital signs and hematological parameters between this surgery and laparotomic gastrectomy. Methods Of 188 patients who underwent distal gastrectomy for preoperatively diagnosed early gastric cancer between January 2004 and September 2006, 87 underwent laparoscopy-assisted distal gastrectomy (LADG) and 101 underwent laparotomic distal gastrectomy (DG). The invasiveness of the two procedures was evaluated in 164 patients with no postoperative complications (82 cases of LADG and 82 cases of DG by measuing vital signs daily and performing hematological examination on postoperative days (POD) 1, 4, 7, and 10. Results For body temperature, heart rate, and blood pressure, significantly lower values were obtained with LADG on 3 and 4 POD, 4 POD, and 3 and 4 POD, respectively. For white blood cell counts (WBC) and C-reactive protein (CRP), significantly lower values were obtained with LADG on 7 and 10 POD, and 10 POD, respectively. For serum protein levels and lymphocyte counts, significantly higher values were obtained with LADG on 1, 4, 7, and 10 POD, and 4 and 10 POD, respectively. Body temperature, WBC, and CRP showed no significant difference immediately after surgery but earlier recovery occurred with LADG. For protein levels and lymphocyte counts, higher values were obtained immediately after surgery. There seemed to be two patterns of less invasiveness in the parameters: the early recovery found for body temperature, WBC and CRP, and the smaller shift immediately after surgery in protein level and lymphocyte count, and probably, heart rate and blood pressure. The complication rate was 18.8% for DG and 5.7% for LADG. Conclusions LADG is a less-invasive surgical procedure as it produces early normalization or smaller shifts in various parameters and exhibits a low prevalence of complications.     

The course of inflammatory mediators after elective orthopedic interventions

PURPOSE OF THE STUDY: The aim of the study was to characterize the changes of C-reactive protein, erythrocyte sedimentation rate, white blood count and body temperature by serial measurements after different types of uncomplicated orthopedic surgery. METHODS: The uncomplicated course of 180 patients after elective total hip and knee arthroplasties, ventral and dorsal spinal fusions and diagnostic knee and shoulder arthroscopies were analyzed. RESULTS: The maximal CRP-values were recorded on the second or third day after operation. The peak levels correlated with the extent of the procedures and reached 1.28-17.71 mg/dl. The ESR increased to maximal rates five to six days after surgery and remained elevated during the 14 days of the investigation period. WBC and body temperature showed a slow and uncharacteristic increase followed by a slow and irregular decrease. CONCLUSION: Awareness of the typical pattern of CRP, ESR, WBC and body temperature may help to evaluate the early postoperative course. The CRP is a sensitive marker. ESR, WBC and body temperature are less costly but a poor diagnostic aid for the early detection of postoperative complications especially infections.     

全髋关节置换术后延迟感染的二期翻修

目的全髋关节置换术(THA)后感染中延迟感染比例较高,治疗困难.该文着重探讨这类感染病例二期翻修的方法. 方法对2000年至2004年20例THA后延迟感染病人进行回顾性分析.其中男8例,女12例,平均年龄57.2岁(48～72岁).细菌培养3例阳性,17例阴性;起病距初始手术平均7.1个月(3～20个月);一期手术前血沉和C 反应蛋白(CRP)均明显增高.所有病例均采用一期彻底清创、假体取出和二期翻修的方法.间隔期内每周监测血沉和CRP,二次翻修术前停用抗生素至少2周. 结果一期术后6周内所有病人血沉和CRP均降至正常.16例病人间隔期为8～9周,4例为15～19周.翻修术后细菌培养均为阴性.平均随访28.6个月,无一例感染复发.Harris评分较术前平均提高52.3分(P<0.01). 结论一期手术彻底清创、血沉和CRP监测及合适的二期翻修时机是成功控制THA后延迟感染的关键,可获得满意的临床疗效.