Can serum C-reactive protein determine the timing of reimplantation in two-stage revised arthroplasty for periprosthetic hip infection?

J Orthop Sci. 2024 Jul;29(4):1031-1036. doi: 10.1016/j.jos.2023.07.005. Epub 2023 Jul 26.

Abstract

Background: There are no definitive guides to determine the timing of reimplantation in two-stage revision total hip arthroplasties (THA) for periprosthetic joint infection (PJI). This study was to design to support a rational strategy of surgical treatment using serum C-reactive protein (CRP).

Methods: We analyzed a total of 75 hips for PJI in the process of performing two-stage and multiple-stage revision THAs. CRP level was retrospectively evaluated every week and transformed to log2 (CRP) using a logistic regression model. Prosthesis survival from recurrent infection was determined by Kaplan-Meier analysis, using implant removal as the endpoint. Receiver operating characteristic curves were calculated using each log2 (CRP) to assess predictions of recurrent infection.

Results: The 10-year survival rates were 85% (95% confidence interval, 76-95) and 100% for two-stage and multiple-stage revision THAs, respectively. Preoperatively, at 1, 2, 3, and 5 weeks, log2 (CRP) was not associated with recurrent infection. In failed two-stage revision THAs, log2 (CRP) at 3 weeks divided by that at 2 weeks showed a significant difference. Failure was associated with a ratio of >4.0 for the CRP level between 3 and 2 weeks.

Conclusion: In two-stage revision THA for PJI, patients with CRP elevation from 2 weeks to 3 weeks, especially 4-fold elevation, suggests the need for further debridement and postponement of second-staged reimplantation.

Keywords: C-reactive protein; Infection; Log2; Total hip arthroplasty; Two-stage revision.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Biomarkers / blood
  • C-Reactive Protein* / analysis
  • C-Reactive Protein* / metabolism
  • Female
  • Hip Prosthesis / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Prosthesis-Related Infections* / blood
  • Prosthesis-Related Infections* / etiology
  • Prosthesis-Related Infections* / surgery
  • Reoperation*
  • Replantation / methods
  • Retrospective Studies
  • Time Factors

Substances

  • C-Reactive Protein
  • Biomarkers