Perioperative Testing for Persistent Sepsis Following Resection Arthroplasty of the Hip for Periprosthetic Infection

Abstract Eighty-seven hips with an infected total hip arthroplasty were treated with an antibiotic spacer and 6 weeks of antibiotics. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) measurements were repeated before attempted reimplanation, and a synovial fluid white blood cell...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of arthroplasty 2010-09, Vol.25 (6), p.87-91
Main Authors: Shukla, Sanjai K., MD, Ward, Joseph P., BA, Jacofsky, Marc C., PhD, Sporer, Scott M., MD, Paprosky, Wayne G., MD, Della Valle, Craig J., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Arthroplasty, Replacement, Hip
Blood Sedimentation
C-reactive protein
C-Reactive Protein - metabolism
erythrocyte sedimentation rate
Female
Hip Prosthesis - microbiology
Humans
infection
Leukocyte Count
Male
Middle Aged
Orthopedics
Perioperative Care
Prosthesis-Related Infections - drug therapy
Prosthesis-Related Infections - surgery
Reoperation
Sensitivity and Specificity
Sepsis - blood
Sepsis - diagnosis
Sepsis - drug therapy
Synovial Fluid
synovial fluid white blood cell count
total hip arthroplasty
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Eighty-seven hips with an infected total hip arthroplasty were treated with an antibiotic spacer and 6 weeks of antibiotics. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) measurements were repeated before attempted reimplanation, and a synovial fluid white blood cell (WBC) count was obtained intraoperatively. Nine hips (10.1%) had persistent infections. The mean ESR, CRP, and synovial fluid WBC count and differential decreased significantly ( P < .001) between stages; however, the ESR remained elevated (>30 mm/h) in 50 patients (62.5%) and the CRP remained elevated (>10 mg/L) in 22 patients (27.5%) in whom the infection had been eradicated. The synovial fluid WBC count was the best test for identifying persistent infection, with an optimum cutoff of 3528 WBCs/ µ L(sensitivity, 78%; specificity, 96%) and an area under the curve of 0.91. The ESR and CRP were not sufficiently rigorous to aid in diagnosis and frequently failed to normalize even in patients without persistent infection.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2010.05.006