Rothman Institute of Orthopedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
Clin Orthop Relat Res. 2013 Oct;471(10):3186-95. doi: 10.1007/s11999-013-3070-z.
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily.
QUESTIONS/PURPOSES: Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis.
We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds.
ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively.
The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds.
Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
红细胞沉降率（ESR）和 C 反应蛋白（CRP）最近被建议作为诊断假体周围关节感染（PJI）的标准。由于这些标志物的阈值是任意确定的，因此应重新检查。
问题/目的：基于最近定义的 PJI 标准，我们确定（1）ESR 和 CRP 的阈值在髋关节和膝关节之间是否存在差异，（2）ESR 和 CRP 的阈值是否应因早期术后和晚期慢性 PJI 而有所不同，以及（3）PJI 诊断中 ESR 和 CRP 的最佳阈值。
我们回顾性分析了 2000 年至 2009 年间因无菌性失败（1095 髋，594 膝）或初次发生 PJI（108 髋，165 膝）行翻修关节成形术的 1962 例患者。PJI 的诊断是根据最近由肌肉骨骼感染学会提出的标准，独立于 ESR 和 CRP 进行的。未包括有影响 ESR 和 CRP 的合并症的患者。进行了接收器工作特征（ROC）分析以确定阈值。
晚期慢性 PJI 中膝关节的 ESR 和 CRP 水平高于髋关节。髋关节和膝关节的 ESR 和 CRP 的最佳阈值分别为 48.5 mm/小时和 13.5 mg/L，46.5 mm/小时和 23.5 mg/L。在早期术后 PJI 中，两个关节的 ESR 和 CRP 相似，其共同阈值分别为 54.5 mm/小时和 23.5 mg/L。
数据表明，晚期慢性髋关节和膝关节的 ESR 阈值应相似，但 CRP 则不应如此。最佳幅度高于传统阈值，这表明如果要将 ESR 和 CRP 作为 PJI 诊断标准，则需要对阈值进行细化。早期术后和晚期慢性 PJI 可能需要不同的阈值。
三级，诊断研究。请参阅作者说明，以获取完整的证据水平描述。
