Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections
Open Access
- 8 June 2021
- journal article
- research article
- Published by Copernicus GmbH in Journal of Bone and Joint Infection
- Vol. 6 (6), 229-234
- https://doi.org/10.5194/jbji-6-229-2021
Abstract
Introduction: The gold standard for determining the duration of periprosthetic joint infection (PJI) is a thorough history. Currently, there are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP (mg/L) in joint arthroplasty. This study suggests the ESR / CRP ratio will help differentiate acute from chronic PJI. Methods: Retrospective review of patients with PJI was performed. Inclusion criteria: patients >18 years old who underwent surgical revision for PJI and had documented ESR and CRP values. Subjects were divided into two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the ESR / CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR / CRP ratio in characterizing the duration of PJI. Results: 147 patients were included in the study (81 acute and 66 chronic). The mean ESR / CRP ratio in acute patients was 0.48 compared to 2.87 in chronic patients (p0.96) vs. acute (<0.96) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62–0.83) and the specificity was 0.90 (95 % CI 0.81–0.94). Conclusions: The ESR / CRP ratio may help determine the duration of PJI in uncertain cases. This metric may give arthroplasty surgeons more confidence in defining the duration of the PJI and therefore aid in treatment selection.Keywords
This publication has 35 references indexed in Scilit:
- Two-stage Treatment of Hip Periprosthetic Joint Infection Is Associated With a High Rate of Infection Control but High MortalityClinical Orthopaedics and Related Research, 2012
- Two-stage Exchange Arthroplasty for Infected Total Knee Arthroplasty: Predictors of FailureClinical Orthopaedics and Related Research, 2011
- Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint InfectionClinical Orthopaedics and Related Research, 2011
- New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection SocietyClinical Orthopaedics and Related Research, 2011
- The Mark Coventry Award: Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid AnalysisClinical Orthopaedics and Related Research, 2011
- Irrigation and Debridement in the Management of Prosthetic Joint Infection: Traditional Indications RevisitedThe Journal of Arthroplasty, 2010
- Receiver Operating Characteristic Curve in Diagnostic Test AssessmentJournal of Thoracic Oncology, 2010
- Two Stage Hip Revision in Periprosthetic Infection: Results of 41 CasesThe Open Orthopaedics Journal, 2010
- Increasing risk of revision due to deep infection after hip arthroplastyActa Orthopaedica, 2009
- Prosthetic-Joint InfectionsThe New England Journal of Medicine, 2004