Analysis of the Causes of Elevated C-Reactive Protein Level in the Early Postoperative Period After Primary Total Knee Arthroplasty
Analysis of the Causes of Elevated C-Reactive Protein Level in the Early Postoperative Period After Primary Total Knee Arthroplasty
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DOI：
10.1016/j.arth.2016.02.037
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发表时间：
2016-09-01
影响因子：
3.5
通讯作者：
Lee, Beom Koo
中科院分区：
文献类型：
--
作者：
Kim, Tae Won;Kim, Dong Hwan;Lee, Beom Koo
背景：C反应蛋白（CRP）水平的测量作为急性假体周围感染的筛查试验具有高敏感性和低特异性。我们进行本研究来分析初次全膝关节置换术 (TKA) 术后早期 CRP 水平升高的原因。本研究旨在通过了解术后CRP升高的相关因素来帮助患者的术后护理。方法：对2005年1月至2013年5月期间接受初次TKA的627例患者的记录进行检查。我们排除了 50 名进行了炎症性关节炎 TKA 或翻修 TKA 的患者。我们在术后 4 周早期连续测量了所有纳入病例的 CRP 水平，以发现 CRP 模式呈升高-降低-升高（双峰模式）的病例。我们分析了具有双峰 CRP 变化模式的患者 CRP 水平再次升高的原因。结果：在纳入的 577 名患者中，76 例表现出双峰 CRP 升高模式。 18 例升高是由术后感染（假体周围感染）引起的，10 例由心血管问题引起，11 例由胃肠道问题引起，12 例由泌尿系统问题引起，10 例由呼吸系统问题引起，15 例原因不明。结论：我们的研究表明 TKA 后 CRP 水平升高可能有多种原因。尽管 CRP 升高可能还有其他原因，但对假体关节感染进行检查至关重要。此外，除了假体周围感染之外，似乎还需要评估非感染性原因和其他部位的感染。 (C) 2016 Elsevier Inc. 保留所有权利。
Background: Measurement of C-reactive protein (CRP) levels as a screening test for acute periprosthetic joint infection has high sensitivity and low specificity. We performed the present study to analyze the causes of elevated CRP levels in the early postoperative period after primary total knee arthroplasty (TKA). This study is intended to help the postoperative care of patients through understanding the factors associated with postoperative elevation of CRP.Methods: The records for 627 patients who underwent primary TKA between January 2005 and May 2013 were examined. We excluded 50 patients for whom TKA with inflammatory arthritis or revision TKA was performed. We measured serial CRP levels during the 4-week early postoperative period in all included cases to find the cases that showed a CRP pattern of elevation-depression-elevation (a bimodal pattern). We analyzed the causes of re-elevated CRP levels in patients with a bimodal pattern of CRP change.Results: Of the 577 included patients, 76 showed bimodal CRP elevation patterns. Eighteen elevations were caused by postoperative infections (periprosthetic infection), 10 by cardiovascular problems, 11 by gastrointestinal problems, 12 by urologic problems, 10 by respiratory problems, and 15 had unknown origins.Conclusion: Our study shows that elevated CRP levels after TKA can have various causes. Although there may be other causes for an elevated CRP, it is essential to perform a work-up for prosthetic joint infections. In addition, there seems to be a need to evaluate noninfectious causes and infection of other sites, in addition to periprosthetic infection. (C) 2016 Elsevier Inc. All rights reserved.