Serological markers can lead to false negative diagnoses of periprosthetic infections following total knee arthroplasty
- 23 December 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Orthopaedics
- Vol. 35 (11), 1621-1626
- https://doi.org/10.1007/s00264-010-1175-5
Abstract
Periprosthetic infections following total knee arthroplasty (TKA) are diagnostically challenging. We evaluated the sensitivity and specificity of ESR and CRP, false negative rates, whether false negative rates differed between early post-operative and late infections, and the predictive ability of ESR and CRP to differentiate infected patients. Between 2000 and 2007, a prospectively collected database was reviewed to identify patients with suspected periprosthetic infections, and who had ESR and CRP laboratory values. One hundred and thirteen patients were identified. False negative rates were calculated. Finally, receiver operating characteristic curves were used to determine the predictive ability of ESR and CRP to differentiate infected from non-infected patients. CRP had a sensitivity of 95% and specificity of 20%. ESR had a sensitivity of 91% and a specificity of 33%. The false negative rate was 9.2% for ESR, 5.3% for CRP, and 11.1% for combined ESR and CRP. False negative rates were higher for early post-operative infections. Although ESR and CRP can be excellent adjunctive diagnostic tools, we emphasise that because some patients may not mount a sufficient immune response, the entire clinical picture must be evaluated, and periprosthetic infection should not be ruled out on the basis of ESR and CRP results alone.Keywords
This publication has 21 references indexed in Scilit:
- Prosthetic Joint Infection Risk after TKA in the Medicare PopulationClinical Orthopaedics & Related Research, 2010
- The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplastyInternational Journal of Infectious Diseases, 2009
- Staged Revision for Knee Arthroplasty Infection: What Is the Role of Serologic Tests Before Reimplantation?Clinical Orthopaedics & Related Research, 2009
- Diagnosis of Infected Total Knee: Findings of a Multicenter DatabaseClinical Orthopaedics & Related Research, 2008
- A Simple, Cost-Effective Screening Protocol to Rule Out Periprosthetic InfectionThe Journal of Arthroplasty, 2008
- Preoperative Evaluations in Revision Total Knee ArthroplastyClinical Orthopaedics and Related Research, 2006
- Diagnosis of Periprosthetic InfectionThe Journal of Bone & Joint Surgery, 2006
- Infection after total knee arthroplastyThe Journal of Bone and Joint Surgery. British volume, 2004
- Prosthetic Joint Infections: Bane of Orthopedists, Challenge for Infectious Disease SpecialistsClinical Infectious Diseases, 2003
- Infection in Total Knee ReplacementPublished by Ovid Technologies (Wolters Kluwer Health) ,2001