Ulf Krister Hofmann (Aachen / DE), Moritz Mederake (Tübingen / DE), Sebastian Benda (Markgröningen / DE), Philipp Schuster (Markgröningen / DE), Bernd Fink (Markgröningen / DE)
Abstract text (incl. references and figure legends)
Background:
Hip arthroplasty is one of the most frequent surgeries worldwide. Despite exquisite surgical technique and modern implants, incidence of periprosthetic joint infection (PJI) remains at around 1% of operated patients. Clinical manifestation of PJIs is highly variable and depends on numerous factors such as the immune competence of the patient or pathogenicity of the causative organism. Although not so impressive in their presentation, low-grade PJIs are particularly difficult to treat. As standard treatment strategy, the prosthesis is explanted in a first step accompanied by aggressive debridement. After a few weeks of targeted antibiotic treatment, the new prosthesis is implanted in a second operation. To date, there are no means available to judge treatment success in that inter-operation interval. Aim of the present study was to evaluate serum CRP and white blood cell (WBC) count for their potential to serve as diagnostic values.
Materials and Methods:
117 patients who had undergone two-stage septic hip revision surgery were retrospectively analysed and their outcome was compared to serum blood values.
Results:
Median follow-up was 51 months, with 91% of patients remaining free of infection. Both CRP and WBC count values dropped significantly during the interoperative interval (p=0.001). When comparing the development of both parameters between those patients with later reinfection with those that remained free of infection, interestingly no significant difference was observed (CRP p=0.131; WBC count p=0.424). Diagnostic value of both parameters was low with a ROC-area under the curve of 0.5-0.6.
Conclusion:
Despite their widespread use in clinical practice, CRP and WBC count seem to be of no diagnostic value in monitoring low-grade PJIs in two stage septic hip revision.
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