Plasma Fibrin Degradation Product and D-Dimer Are of Limited Value for Diagnosing Periprosthetic Joint Infection

BackgroundAlthough the Musculoskeletal Infection Society introduced the use of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as inflammatory markers for diagnosing periprosthetic joint infection (PJI), no single blood marker reliably detects infection before revision arthroplasty. We therefore posed 2 questions: (1) Are fibrin degradation product (FDP) and D-dimer of value for diagnosing PJI before revision arthroplasty? (2) What are their sensitivity and specificity for that purpose?MethodsTo answer these questions, we retrospectively enrolled 318 patients (129 with PJI [group A], 189 with aseptic mechanical failure [group B]) who underwent revision arthroplasty during 2013-2018. Receiver operating characteristic curves were used to determine maximum sensitivity and specificity of the 2 markers. Inflammatory and fibrinolytic markers were evaluated based on (1) the Tsukayama-type infection present and (2) the 3 most common PJI-related pathogens.ResultsFDP and D-dimer levels were higher in group A than in group B: 4.97 ± 2.83 vs 4.14 ± 2.67 mg/L and 2.14 ± 2.01 vs 1.51 ± 1.37 mg/L fibrinogen equivalent units (FEU), respectively (both P < .05). Based on the Youden index, 2.95 mg/L and 1.02 mg/L FEU are the optimal FDP and D-dimer predictive cutoffs, respectively, for diagnosing PJI. Sensitivity and specificity, respectively, were 65.12% and 60.33% (FDP) and 68.29% and 50.70% (D-dimer). ESR, CRP, and interleukin-6 values were diagnostically superior to those of FDP and D-dimer.ConclusionThe value of plasma FDP and D-dimer for diagnosing PJI is limited compared with traditional inflammatory markers (ESR, CRP, interleukin-6) before revision arthroplasty.     

白细胞介素-6在初次人工关节置换术后的变化规律及意义

目的探讨人工关节置换前后血清炎性指标IL-6的变化规律,结合CRP、ESR变化规律进一步分析三者的变化异同,并为人工关节置换术后感染早期发现提供参考依据。方法选取2011年10月至2012年04月本组204例初次置换患者为研究对象,分别于术前、术后1d、2d、3d及5d时对患者的血清IL-6,术前、术后1d、3d及5d时患者的血清CRP、ESR进行检测分析,并加以比较。结果测量数据显示,所有患者的血清IL-6、CRP、ESR水平均呈先升高后下降的趋势,其中血清IL-6在人工关节置换术后2d达到高峰,术后2d开始下降,5d下降到正常范围内,术后1、2及3d的IL-6均高于术前,有统计学差异（t1d=11.24,t2d=10.83,t3d=2.63,P〈0.05）;术后5d与术前比较,无统计学差异（t5d=0.47,P〉0.05）。CRP在关节置换后2～3d达到高峰,随后回落,但第5天时未回落到术前水平。ESR在关节置换后4～5d达到高峰,随后回落,但5d时未回落到术前水平。结果 IL-6在人工关节置换术后患者中呈现一定变化规律,先迅速升高后快速下降,变化速度最快,恢复到正常值的速度也快,比CRP及ESR更敏感。结论 IL-6、CRP、ESR三者联合应用更能提高人工关节周围感染的早期诊断率。患者术前髋、膝关节血清IL-6有统计学差异,可能与关节的自身生理结构导致的关节炎机制不同或者髋、膝关节IL-6的受体表达方式不同有关。     

D-Dimer,Erythrocyte Sedimentation Rate,and C-Reactive Protein Sensitivities for Periprosthetic Joint Infection Diagnosis

BackgroundThere is contradicting evidence on the diagnostic value of inflammatory biomarkers for periprosthetic joint infection (PJI). We sought to quantify the sensitivity of D-dimer for acute and chronic PJI diagnosis and evaluate D-dimer lab values in the 90-day postoperative window in a control cohort of primary joint arthroplasty patients for comparison.MethodsAn institutional database was queried for patients undergoing revision procedures for PJI after total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2014 to present. CRP, ESR, and D-dimer were collected within 90 days pre and postoperatively and sensitivities for the diagnosis of PJI were calculated. The control group included patients who underwent a negative diagnostic workup for deep venous thrombosis (DVT) or pulmonary embolus (PE) and had a D-dimer lab collected within 90 days postoperatively from primary total joint arthroplasty (TJA).ResultsA total of 604 PJI patients were identified, and 81 patients had D-dimer, ESR, and CRP collected. There were 50/81 acute PJI patients and 31/81 chronic PJI patients who had median D-dimer values of 2,136.5 ng/mL [interquartile range (IQR): 1,642-3,966.5] and 3,336 ng/mL [IQR: 1,976-5,594]. Only the chronic PJI group had significantly higher D-dimer values when compared to the control cohort (P = .009). The sensitivity of D-dimer was calculated to be 92% and 93.5% in the acute and chronic PJI groups, respectively.ConclusionSerum D-dimer may not have high diagnostic utility for acute PJI, especially in the setting of recent surgery; however, it still may be useful for patients who have chronic PJI.     

C-reactive protein levels after 4 types of arthroplasty

Background and purpose Postoperative C-reactive protein (CRP) levels in serum appear to reflect surgical trauma. We examined CRP levels after 4 types of arthroplasty.

Material and methods We investigated 102 patients who had total knee arthroplasty (TKA), computer navigation-assisted total knee arthroplasty (NAV-TKA), hip resurfacing arthroplasty (metal on metal, MMSA) and total hip arthroplasty (THA), respectively. CRP levels were estimated before surgery and postoperatively at 2 and 7 days.

Results Postoperatively, the peak CRP levels were highest on the second day after surgery in each of the groups. The peak CPR levels after hip resurfacing were lower than those after conventional primary THA. The peak CRP levels after computer navigation-assisted TKA were lower than those after conventional primary TKA.

Interpretation The extent of bone and bone marrow injury rather than the region of surgery or the amount of soft tissue damage appears to determine the extent of the postoperative CRP response.     

Normal sequential changes in neutrophil CD64 expression after total joint arthroplasty

Background

Neutrophil CD64 has been reported to be a sensitive and specific infection marker. Its measurement is thus considered to be useful in early diagnosis of post-operative periprosthetic infection. However, even its normal sequential changes after non-infectious total joint arthroplasty have remained ambiguous. Accordingly, we analyzed 2-week sequential neutrophil CD64 expression changes after total joint arthroplasty in order to clarify its normal postoperative kinetics.

Patients and method

From 41 patients who underwent primary total joint arthroplasties, peripheral blood samples were obtained at 1 day before (baseline) and 1, 3, 5, 7, and 14 days after surgery, and CD64 expression per cell was quantitatively measured. C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) and white blood cell count (WBC) were simultaneously measured.

Results

No cases of postoperative local infection were observed. Levels of CD64 significantly elevated from day 1, peaked at day 3, and decreased significantly following day 5. Statistical analysis confirmed that significant differences existed between the baseline level and the levels at days 1 and 3, while no significant differences existed between the baseline level and those at days 5, 7 or 14. In 17 patients, CD64 peaked at over 2,000 molecules/cell, the level reported to be a cutoff value for distinguishing infection. Multiple regression analysis showed that the sole parameter of baseline CD64 level significantly explained the peak CD64 level. Postoperative CD64 peaks ranged from 1.6 to 2.7 times (median 1.9) the baseline levels. CRP, ESR and WBC also showed rapid elevations and all but WBC remained significantly higher than baseline at day 14.

Conclusion

CD64 levels rise significantly, peaking within about 3 days following normal total joint arthroplasty, but decrease rapidly to near baseline within about 5 days. The data obtained can be expected to form a possible basis for early diagnosis of postoperative periprosthetic infection.     

Relationship of serum IL-6, C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty: a prospective study

Knee osteoarthritis is a common cause of severe pain and functional limitation. Total knee arthroplasty is an effective procedure to relieve pain, restore knee function, and improve quality of life for patients with end stage knee arthritis. The aim of this study was to investigate the inflammatory process in patients with primary knee osteoarthritis before surgery and in subsequent periods following total knee arthroplasty. A prospective study of 49 patients undergoing primary total knee replacements was conducted. The patients were evaluated by monitoring serum interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), knee skin temperature, and clinical status. Measurements were carried out preoperatively and postoperatively on day one and at two, six, 14, and 26 weeks during follow-up review in the knee clinic. The serum IL-6 and CRP were elevated on the first postoperative day but fell to preoperative values at two weeks postoperatively. Both returned to within the normal range by six weeks postoperatively. In addition, the postoperative ESR showed a slow rise with a peak two weeks after surgery and returned to the preoperative level at 26 weeks postoperatively. The difference in skin temperature between operated and contralateral knees had a mean value of +4.5°C at two weeks. The mean value decreased to +3.5°C at six weeks, +2.5°C at 14 weeks, and +1.0°C at 26 weeks. The difference in skin temperature decreased gradually and eventually there was no statistically significant difference at 26 weeks after surgery. A sustained elevation in serum IL-6, CRP, ESR, and skin temperature must raise the concern of early complication and may suggest the development of postoperative complication such as haematoma and/or infection.     

Postoperative changes of early-phase inflammatory indices after uncomplicated anterior cervical discectomy and fusion using allograft and demineralised bone matrix

Purposes

We investigated sequential levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in uncomplicated ACDF (anterior cervical discectomy and fusion) using allograft and DBM (demineralised bone matrix) for primary cervical spondylosis and/or disc herniation. To our knowledge, there has been no study to investigate the diagnostic value of CRP and ESR for postoperative infection in ACDF using allograft and DBM.

Methods

Blood samples of 85 patients, who underwent one- (n = 51) or two-level (n = 34) ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, 14th, 30th, and 90th postoperative days. No infection was found in any patient for at least one year follow-up period.

Results

Mean CRP value increased significantly on the first postoperative day and reached a peak on the third postoperative day. The peak level rapidly decreased but remained elevated on the fifth, seventh, and 14th postoperative days. Mean ESR value increased significantly and reached a peak on the third postoperative day. The peak level gradually decreased but remained elevated on the fifth and seventh postoperative days. One- and two-level ACDF exhibited similar postoperative changes in CRP and ESR values and no significant difference in mean levels of CRP and ESR throughout the follow-up periods.

Conclusions

This study demonstrates that uncomplicated ACDF using allograft and DBM showed significant abnormal values of CRP and ESR during the early postoperative period. This result suggests that abnormal values of CRP and ESR in the early postoperative period do not indicate acute postoperative infection after ACDF using allograft and DBM. Straying from the normal course, such as a second rise or a failure to decrease, of CRP and ESR is more important to signpost acute postoperative infection in ACDF using allograft and DBM.     

Serum C-reactive protein in patients undergoing elective shoulder arthroplasty. Prospective study

Background

The objective of the study was to determine the normalization curve of the serum C-reactive protein (CRP) in elective shoulder arthroplasty.

Infection surveillance in transsphenoidal pituitary surgery - comparison of lipopolysaccharide-binding-protein, interleukin 6, C-reactive protein, white blood cell count, erythrocyte sedimentation rate and body temperature

Background

One of the major concerns in transsphenoidal surgery are infections because the approach to the pituitary includes a route of microbial colonization. To minimize the associated morbidity and mortality, a surveillance program is crucial to monitor for perioperative infections.

Methods

For 1 year, we analysed body temperature (BT), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), C-reactive protein (CRP), interleukin 6 (IL-6) and lipopolysaccharide-binding-protein (LBP) following elective transsphenoidal pituitary surgery. Samples were collected on admission, day 1, 3 and 7 as well as 3 months postoperatively.

Results

In 116 patients, all data were available. No postoperative infections occurred within the first postoperative week. BT (37.6?±?0.6, baseline 37.0?±?0.5 °C), WBC (11,366?±?2,541, baseline 6,861?±?2,123/μl), CRP (25.3?±?22.6, baseline 3.1?±?6 mg/l), IL-6 (12?±?13, baseline 2.7?±?2.6 pg/ml), and LBP (11.3?±?4.9, baseline 5.7?±?2.7 μg/ml) peaked on day 1 postoperatively (each p?=?0.001), while ESR peaked on day 3 (25?±?16, baseline 13?±?11 mm/h, p?=?0.001). BT and IL-6 normalized by day 3 and CRP by day 7, while ESR (23?±?16 mm/h, p?=?0.001), WBC (7,807?±?2,750/μl, p?=?0.001) and LBP (7.3?±?2.6 μg/ml, p?=?0.028) were still increased by day 7.

Conclusion

The present study establishes normative values for an infection surveillance following transsphenoidal pituitary surgery. CRP, a convenient and reasonable priced parameter, is affected by the procedure for the first postoperative week. IL-6 is more robust and allows a close monitoring on the expense of additional pricing. ESR, WBC and LBP are sustained affected by surgery, and do not offer any advantage. Since no infections were observed, we were unable to calculate the respective sensitivity and specificity.     

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。     

Is D-dimer a Reliable Serum Marker for Shoulder Periprosthetic Joint Infection?

BackgroundThe diagnosis of periprosthetic shoulder infection continues to be difficult to make with confidence. Serum D-dimer has proven to be effective as a screening tool for periprosthetic joint infection in other major joints; however, it has yet to be evaluated for use in periprosthetic shoulder infection.Questions/purposes(1) Is D-dimer elevated in patients with probable or definite periprosthetic shoulder infections? (2) What is the diagnostic accuracy of D-dimer for periprosthetic shoulder infections? (3) What are the diagnostic accuracies of serum tests (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and D-dimer), singly and in combination?MethodsBetween March 2016 and March 2020, 94 patients undergoing revision total shoulder arthroplasty (anatomic or reverse) at a single institution had preoperative serum testing with CRP, ESR, and D-dimer. These 94 patients were a subset of 189 revision shoulder arthroplasties performed at this institution during the study period who met inclusion criteria and consented to participate. Included patients had a mean ± SD age of 69 ± 8 years, and 56% (53 of 94) were men. Patient records were reviewed to classify patients as definitely having infection, probably having infection, possibly having infection, or unlikely to have an infection, according to the International Consensus Meeting (ICM) definition of periprosthetic shoulder infection. Statistical analyses, including a receiver operating characteristic curve analysis, were performed to quantify the diagnostic value of D-dimer for periprosthetic shoulder infection. Based on the ICM definition, 4% (4 of 94), 15% (14 of 94), 14% (13 of 94), and 67% (63 of 94) of patients had definite, probable, possible, or unlikely periprosthetic shoulder infections.ResultsD-dimer was elevated in patients with definite or probable infections (median [range] 661 ng/mL [150 to 8205]) compared with those with possible infections or those who were unlikely to have an infection (263 ng/mL [150 to 3060]; median difference 143 ng/mL [95% CI 40 to 503]; p = 0.01). In the receiver operating characteristic curve analysis, D-dimer had an area under the curve of 0.71 (0.50-0.92), demonstrating weak diagnostic value. A D-dimer level of 598 ng/mL provided a sensitivity and specificity of 61% (95% CI 36% to 82%) and 74% (95% CI 62% to 83%), respectively, for diagnosing a definite or probable infection according to the ICM definitions. The specificity of detecting periprosthetic joint infection (88% [95% CI 79% to 94%]) was high when three positive serum markers (ESR, CRP, and D-dimer) were required, at the expense of sensitivity (28% [95% CI 10% to 53%]).ConclusionIn periprosthetic shoulder infection, D-dimer is elevated. However, similar to other serum tests, it has limited diagnostic utility in identifying patients with periprosthetic shoulder infection. Further work is needed to understand the process by which D-dimer is associated with active infection.Level of EvidenceLevel III, diagnostic study.     

Mini-incision total hip arthroplasty: a quantitative assessment of laboratory data and clinical outcomes

In this study, we used laboratory data and clinical outcomes to evaluate the degree of approach-related trauma in mini-incision arthroplasty. In 94 patients (8 male and 86 female), a total of 100 osteoarthritic joints were replaced using total hip arthroplasty (THA). The level of serum C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were measured 1 week postoperatively in both the standard group and a mini-incision group. The serum CRP level (mean ± standard deviation) was 3.3 ± 2.6mg/dl in the standard incision group compared to 1.8 ± 1.2 in the mini-incision group. The ESR level was 66 ± 22mm/h in the standard incision group and 52 ± 20mm/h in the mini-incision group. The ratio of the level of creatine phosphokinase (CPK) measured postoperatively/preoperatively was 4.7 on the first postoperative day in the standard incision group and 3.6 in the mini-incision group. On the basis of the CRP and ESR levels, the mini-incision THA was considered to be less invasive. However, there was no significant difference in the day 1 CPK ratios between the two groups, suggesting that the degree of muscle trauma was similar.     

Comparison of a Comprehensive Set of Fibrinolytic Markers With C-Reactive Protein and Erythrocyte Sedimentation Rate for the Diagnosis of Periprosthetic Joint Infection

BackgroundThe diagnosis of periprosthetic joint infection (PJI), a serious complication after primary total joint arthroplasty, remains challenging. Recently, fibrinolytic activities have been shown to be closely related to infections and inflammation. However, data assessing the value of fibrinolytic markers for the diagnosis of PJI have been sparse until now.MethodsWe retrospectively enrolled 157 patients undergoing revision for aseptic loosening (n = 106, group A) or revision for chronic PJI (n = 51, group B) from January 2014 to August 2019. PJI was defined using the Musculoskeletal Infection Society criteria. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, fibrin degradation product (FDP), and fibrinogen were measured preoperatively. The diagnostic values of each biomarker were analyzed and compared using receiver operating characteristic curves, sensitivity, and specificity.ResultsCompared with group A, group B had significantly higher levels of CRP, ESR, D-dimer, FDP, and fibrinogen (P < .001). The area under the curve of fibrinogen was 0.914, which was slightly lower than that of CRP (0.924). FDP and D-dimer had area under the curve values of 0.808 and 0.784, respectively. The optimal threshold, sensitivity, and specificity were 3.56 g/L, 86.27%, and 83.96% for fibrinogen; 1.22 mg/L, 66.67%, and 85.85% for D-dimer; and 3.98 μg/mL, 72.55%, and 80.19% for FDP, respectively.ConclusionFibrinolytic markers provided promising diagnostic support for PJI, especially fibrinogen, which had a diagnostic efficiency similar to that of CRP and ESR.     

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。     

股骨颈骨折行髋关节置换术患者血沉、C反应蛋白和D-二聚体的变化及临床意义

目的分析股骨颈骨折行髋关节置换术患者血沉、C反应蛋白和D-二聚体的围手术期水平及其对髋关节置换手术预后判断的临床意义。 方法前瞻性收集髋关节置换术病例共152例，分为骨折组（股骨颈骨折，72例）及骨病组（股骨头坏死、髋关节骨性关节炎、成人髋关节发育不良，80例）。测量两组术前及术后血沉、C反应蛋白及D-二聚体水平，并随访术后两年以上，分析股骨颈骨折行髋关节置换患者术前血沉、C反应蛋白和D-二聚体的水平、围手术期变化特点及其对术后感染、血栓等并发症的预测价值。 结果术后随访6~49个月，平均（29±5）个月。术后随访24个月及以上患者138例，随访率90.8%。骨折组术前血沉为（26.575±6.292）mm/H，骨病组为（16.743±4.235）mm/H，差异有统计学意义（t=11.353，P<0.01）。骨折组术后血沉为（40.424±17.566）mm/H，骨病组为（36.643±11.836）mm/H，差异无统计学意义。骨折组术前C反应蛋白为（28.402±4.103）mg/L，骨病组为（5.666±1.692）mg/L，差异有统计学意义（t=44.133，P<0.001）。骨折组术后C反应蛋白为（75.405±18.345）mg/L，骨病组为（48.062±12.453）mg/L，差异有统计学意义（t=10.812，P<0.05）。骨折组术前D-二聚体为（1.613±0.833）mg/L，骨病组为（0.784±0.175）mg/L，差异有统计学意义（t=8.346，P<0.01），骨折组术后D-二聚体为（3.200±1.106）mg/L，骨病组为（2.852±1.415）mg/L，差异无统计学意义。术后两年随访显示两组均无假体周围感染病例，骨折组2例下肢症状性深静脉血栓形成，骨病组为1例，两组均无肺栓塞病例。骨折组术后两年髋关节Harris评分为（89±6）分，骨病组为（86±14）分，差异无统计学意义。 结论股骨颈骨折行髋关节置换患者的术前血沉、C反应蛋白和D-二聚体存在不同程度升高。经术前仔细筛查排除合并感染性疾病或下肢深静脉血栓后，术前血沉、C反应蛋白和D二聚体的增高并不增加术后假体周围感染率和血栓性并发症。     

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.     

Serum Fibrinogen Test Performs Well for the Diagnosis of Periprosthetic Joint Infection

BackgroundSerum fibrinogen (FIB) is an acute-phase glycoprotein in the infection response that may stop excessive bleeding. The purposes of this study are to determine the value of FIB that can be used to differentiate between periprosthetic joint infection (PJI) and aseptic loosening of the prosthesis, and to determine the clinical significance of FIB for analyzing infection outcomes after first-stage surgery.MethodsThis retrospective study included 90 patients undergoing total knee arthroplasty or total hip arthroplasty revision from January 2015 to August 2019. PJI was confirmed in 53 patients (group A), and the other 37 patients were diagnosed with aseptic loosening of the prosthesis (group B). Only 21 patients in group A documented the results for serum FIB, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) after spacer insertion, so the postoperative serological marker levels of the these patients were also assessed.ResultsThe FIB, CRP, and ESR levels were significantly higher in group A than in group B (P < .001). The area under the receiver operating characteristic curve was highest for FIB at 0.928. Analyses of FIB levels revealed a sensitivity of 79.25% and a specificity of 94.59%. FIB levels were significantly lower in patients with PJI after spacer insertion (P < .001).ConclusionFIB is an adequate test to aid in diagnosing PJI, and it is not inferior to CRP and ESR in distinguishing between PJI and aseptic loosening of the prosthesis. It is an especially useful tool in assessing infection outcomes after first-stage surgery.     

Comparison of markers for muscle damage,inflammation, and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty: A prospective,randomized, controlled trial

It is proposed that the use of biochemical markers for muscle damage and inflammation provides an objective measure on invasiveness in total hip arthroplasty. We analyzed levels of creatine kinase and C‐reactive protein (CRP) after total hip arthroplasty in patients randomized to minimally invasive direct anterior approach or direct lateral approach, also recording consumption of pain medication and levels of pain postoperatively. Eighty‐three patients were operated by the use of anterior approach and eighty using lateral. Creatine kinase and CRP levels were measured preoperatively, creatine kinase directly after surgery, and both creatine kinase and CRP on postoperative day 1 through 4. The use of pain medication and levels of pain were recorded. Creatine kinase were higher in the anterior group compared to the lateral group, reaching statistical significance directly postoperative and on day 4. Levels of CRP did not differ, reaching a maximum of mean 52 mg/L on day 3. The use of pain medication was higher in the lateral group on the day of surgery (p = 0.011), and pain levels were higher on all days in the lateral group (p < 0.007). In conclusion, the use of minimally invasive anterior approach caused less pain, but higher postoperative levels of CK, than the use of direct lateral approach. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1305–1310, 2015.     

C-reactive protein levels after 4 types of arthroplasty

Background and purpose Postoperative C-reactive protein (CRP) levels in serum appear to reflect surgical trauma. We examined CRP levels after 4 types of arthroplasty.Material and methods We investigated 102 patients who had total knee arthroplasty (TKA), computer navigation-assisted total knee arthroplasty (NAV-TKA), hip resurfacing arthroplasty (metal on metal, MMSA) and total hip arthroplasty (THA), respectively. CRP levels were estimated before surgery and postoperatively at 2 and 7 days.Results Postoperatively, the peak CRP levels were highest on the second day after surgery in each of the groups. The peak CPR levels after hip resurfacing were lower than those after conventional primary THA. The peak CRP levels after computer navigation-assisted TKA were lower than those after conventional primary TKA.Interpretation The extent of bone and bone marrow injury rather than the region of surgery or the amount of soft tissue damage appears to determine the extent of the postoperative CRP response.     

C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients With Heterotopic Ossification After Spinal Cord Injury

Abstract

Background/Objective: Formation of heterotopic ossification (HO) in soft tissue afterspinal cord injury (SCI) is associated with various degrees of inflammation. Recent studies have shown that inhibition of inflammatory reaction with nonsteroidal anti-inflammatory drugs is an effective prevention of HO after SCI. The goal of this study was to monitor the activity of the most widely used indicators of acute inflammation-namely, erythrocyte Sedimentation rate (ESR) and C-reactive protein (CRP)-in patients with HO.

Methods: In a retrospective study, the results of 37 patie nts with HO were evaluated. There were 25 patients with tetraplegia and 12 with paraplegia. The age (mean ± SD) of the patients was 2 8 ± 8 years (range = 19-46 years). The patients were admitted to the rehabilitation center 2 to 5 weeks after SCI. HO was confirmed by bone scintigraphy. Blood samples were obtained from the patients at the time of diagnosis of HO and du ring the therapy. ESR was measured with the Westergren method, and serum CRP was determined by enzyme-linked immunosorbent assay.

Results: In the acute stage of HO, both tests were e levated in all patients. ln the later stages when clinical signs and symptoms of inflammat ion were resolving, both tests showed a gradual decline. When clinical sig ns and symptoms of inflammation (fever, acute soft tissue swelling, and erythema) were not present, the concentration of CRP was normal in 91 .2% of patients, whereas only 1 7 .6% of patients had normal ESR. Mean serum concentrations of CRP were 8.9 ±5.6 mg/L in the inflammatory phase and 0.9 ± 0.6 mg/L in the noninflammatory phase.

Conclusion: The data indicate that serum CRP is a useful and more specific test than is ESR for monitaring the inflammatory activity of HO after SCI. The normalization of CRP was seen during the first 3 to 4 weeks of etidronate therapy, indicating a resolution of acute-phase inflammatory reaction.