Optimal ESR and CRP cut-off values based on new criteria for periprosthetic joint infection

March 21, 2013, Thomas Jefferson University

Infections, as the news has shown time and again, can be deadly. Periprothesthetic joint infection (PJI) is the infection of grave concern to the orthopedic community, especially in its growingly common antibiotic-resistant form. This all-too-common infection can be found deep inside the joint prosthesis following joint replacement surgery.

Javad Parvizi, MD, and colleagues at the Rothman Institute at Jefferson have worked for years to find a solution to this sometimes deadly infection. Their most recent work has attempted to determine the optimal thresholds for two common for systemic inflammation and infection. It will be presented on Thursday, March 21, 2013, at 4:06 pm, McCormick Place, Room S105, at the American Academy of Orthopedic Surgeons (AAOS) annual meeting in Chicago.

In previous studies, it was determined that testing the blood for elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), known biomarkers for and infection, was an accurate test for determining the presence of an infection. But, the levels of ESR and CRP that should sound the alarm have been inconsistent, particularly in regard to a new, industry-wide agreed upon definition for PJI.

The team retrospectively reviewed 1,993 patients who underwent revision surgery for aseptic failure (1,095 hips, 594 knees) or PJI (112 hips, 192 knees) between 2000 and 2009. Patients with comorbidities that could elevate the serum inflammatory markers were disqualified from the study.

Analysis was performed to determine the optimal threshold and test characteristics for ESR and CRP in hips and knees separately. The study found that the real threshold for these tests is higher than previously thought. In addition, researchers found that there is a difference between the knee and hip with regard to the extent these inflammatory markers are elevated with PJI.

The study confirmed the utility of ESR and CRP as a combination test in PJI diagnosis in a large cohort at a single institution. "The findings suggest conventional thresholds for these may need to be refined to improve their accuracy in diagnosing PJI," says Dr. Parvizi.

Explore further: A new definition for periprosthetic joint infection

Related Stories

A new definition for periprosthetic joint infection

November 4, 2011
A rise in periprosthetic joint infection (PJI) rates has the orthopedic community moving to develop it's first-ever agreed upon definition and diagnostic criteria to help better treat patients.

Research suggests use of LE strips to diagnose PJI

February 7, 2012
Rothman Institute at Jefferson joint researchers continue to seek better ways to diagnose and subsequently treat periprosthetic joint infection (PJI) in patients following total joint arthroplasty. Their latest research shows ...

Rothman at Jefferson research suggests abandon convention in diagnosing periprosthetic joint infection

February 8, 2012
In their search for new, better ways to diagnose periprosthetic joint infection, Rothman Institute at Jefferson researchers have discovered that measurement of C-reactive protein in the synovial fluid is extremely accurate, ...

Evidence insufficient to recommend routine antibiotics for joint replacement patients

December 18, 2012
The American Academy of Orthopaedic Surgeons (AAOS), and the American Dental Association (ADA) found that there is insufficient evidence to recommend the routine use of antibiotics for patients with orthopaedic implants to ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.