Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
Abstract Background Serum C-reactive protein (CRP) trends are critical for monitoring patients’ treatment response following a two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of the hip. However, CRP trends are poorly described in the literature. The primary aim of this stud...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-021-04893-3 |
| _version_ | 1818721985157398528 |
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| author | Zhong-Yan Li Yu-Chih Lin Chih-Hsiang Chang Szu-Yuan Chen Tung-Wu Lu Sheng-Hsun Lee |
| author_facet | Zhong-Yan Li Yu-Chih Lin Chih-Hsiang Chang Szu-Yuan Chen Tung-Wu Lu Sheng-Hsun Lee |
| author_sort | Zhong-Yan Li |
| collection | DOAJ |
| description | Abstract Background Serum C-reactive protein (CRP) trends are critical for monitoring patients’ treatment response following a two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of the hip. However, CRP trends are poorly described in the literature. The primary aim of this study was to identify the relationships between PJI treatment outcomes and our proposed CRP trend definitions, parameters, and microbiological data. The secondary aim was to investigate CRP trends after the occurrence of spacer-related complications. Methods We conducted a retrospective review of 74 patients treated with a two-stage exchange protocol for PJI in a tertiary referral joint center between 2014 and 2016. Patients with factors that may affect CRP levels (inflammatory arthritis, concomitant infections, liver and kidney diseases, and intensive care admissions) were excluded. CRP trends were categorized into five types and PJI treatment outcome was defined as “success” or “failure” according to the Delphi criteria. Results Treatment was successful in 67 patients and failed in 7 patients. Multivariate logistic regression analysis showed that type 5 CRP, defined as serum CRP fluctuation without normalization after first stage surgery (odds ratio [OR]: 17.4; 95% confidence interval [CI]: 2.3–129.7; p = 0.005), and methicillin-resistant Staphylococcus aureus (MRSA; OR: 14.5; 95% CI: 1.6–131.7; p = 0.018) were associated with treatment failure. Spacer-related complications occurred in 18 patients. Of these, 12 had elevated CRP levels at later follow-up, while six had no elevation in CRP levels. Conclusions We found that MRSA infection and type 5 CRP were associated with PJI treatment failure. |
| first_indexed | 2024-12-17T20:47:25Z |
| format | Article |
| id | doaj.art-5bc5a1b3d5a14b90a79543761fd1d9e5 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-17T20:47:25Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-5bc5a1b3d5a14b90a79543761fd1d9e52022-12-21T21:33:08ZengBMCBMC Musculoskeletal Disorders1471-24742021-12-0122111010.1186/s12891-021-04893-3Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control studyZhong-Yan Li0Yu-Chih Lin1Chih-Hsiang Chang2Szu-Yuan Chen3Tung-Wu Lu4Sheng-Hsun Lee5Department of Biomedical Engineering, National Taiwan UniversityDepartment of Orthopaedic Surgery, Chang Gung Memorial HospitalDepartment of Orthopaedic Surgery, Chang Gung Memorial HospitalDepartment of Orthopaedic Surgery, Chang Gung Memorial HospitalDepartment of Medicine, Chang Gung UniversityDepartment of Orthopaedic Surgery, Chang Gung Memorial HospitalAbstract Background Serum C-reactive protein (CRP) trends are critical for monitoring patients’ treatment response following a two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of the hip. However, CRP trends are poorly described in the literature. The primary aim of this study was to identify the relationships between PJI treatment outcomes and our proposed CRP trend definitions, parameters, and microbiological data. The secondary aim was to investigate CRP trends after the occurrence of spacer-related complications. Methods We conducted a retrospective review of 74 patients treated with a two-stage exchange protocol for PJI in a tertiary referral joint center between 2014 and 2016. Patients with factors that may affect CRP levels (inflammatory arthritis, concomitant infections, liver and kidney diseases, and intensive care admissions) were excluded. CRP trends were categorized into five types and PJI treatment outcome was defined as “success” or “failure” according to the Delphi criteria. Results Treatment was successful in 67 patients and failed in 7 patients. Multivariate logistic regression analysis showed that type 5 CRP, defined as serum CRP fluctuation without normalization after first stage surgery (odds ratio [OR]: 17.4; 95% confidence interval [CI]: 2.3–129.7; p = 0.005), and methicillin-resistant Staphylococcus aureus (MRSA; OR: 14.5; 95% CI: 1.6–131.7; p = 0.018) were associated with treatment failure. Spacer-related complications occurred in 18 patients. Of these, 12 had elevated CRP levels at later follow-up, while six had no elevation in CRP levels. Conclusions We found that MRSA infection and type 5 CRP were associated with PJI treatment failure.https://doi.org/10.1186/s12891-021-04893-3Two-stage exchange arthroplastyPeriprosthetic joint infectionCRP trendsSpacer-related complications |
| spellingShingle | Zhong-Yan Li Yu-Chih Lin Chih-Hsiang Chang Szu-Yuan Chen Tung-Wu Lu Sheng-Hsun Lee Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study BMC Musculoskeletal Disorders Two-stage exchange arthroplasty Periprosthetic joint infection CRP trends Spacer-related complications |
| title | Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study |
| title_full | Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study |
| title_fullStr | Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study |
| title_full_unstemmed | Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study |
| title_short | Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study |
| title_sort | trend of serum c reactive protein is associated with treatment outcome of hip periprosthetic joint infection undergoing two stage exchange arthroplasty a case control study |
| topic | Two-stage exchange arthroplasty Periprosthetic joint infection CRP trends Spacer-related complications |
| url | https://doi.org/10.1186/s12891-021-04893-3 |
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