Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
UAB School of Medicine, Birmingham, AL.
J Arthroplasty. 2020 Jun;35(6S):S319-S324. doi: 10.1016/j.arth.2020.02.035. Epub 2020 Feb 24.
This study sought (1) to assess the value of serological testing prior to conversion total hip arthroplasty (THA) in predicting infection and (2) to identify optimal serological values for routine diagnostic workup prior to conversion THA.
All patients at our tertiary referral center undergoing conversion THA after hip/acetabular fracture procedure from 2013 to 2018 were retrospectively reviewed. Inclusion criteria were patients previously undergoing hemiarthroplasty or open reduction and internal fixation of acetabular, intertrochanteric, and subtrochanteric fractures that progressed to conversion THA due to post-traumatic arthritis having erythrocyte sedimentation rate/C-reactive protein (CRP) prior to conversion. Infection was defined as positive intraoperative cultures not deemed contaminant in collaboration with infectious disease consult and/or development of PJI within 1 year postoperatively.
Twelve of 87 (14%) patients undergoing conversion THA developed infection. The mean erythrocyte sedimentation rate (37.2 vs 24.4 mm/h, P = .2062) and CRP (22.4 vs 9.0 mg/L, P = .0026) in the infected cohort were elevated compared to the noninfected group. An optimal cutoff value for CRP of 12 mg/L (area under the curve = 0.77, 95% confidence interval 0.58-0.97) revealed 75% sensitivity, 84% specificity, 43% positive predictive value, and 95% negative predictive value (P < .0001) in the entire cohort.
Even without clinical signs and symptoms, patients undergoing conversion THA from internal fixation of hip/acetabular fractures are still at high risk for developing periprosthetic joint infection. All patients undergoing conversion THA should have CRP measured preoperatively as a part of the diagnostic workup for underlying infection. Further research should be devoted to creating a preoperative diagnostic algorithm incorporating CRP, similar to Musculoskeletal Infection Society criteria, dedicated to patients undergoing conversion THA.
Level III, Diagnostic retrospective cohort study.
本研究旨在（1）评估在全髋关节置换术（THA）转换前的血清学检测在预测感染方面的价值，以及（2）确定在 THA 转换前常规诊断中进行血清学检测的最佳血清学值。
对 2013 年至 2018 年期间因创伤后关节炎在我们的三级转诊中心接受 THA 转换的所有髋关节/髋臼骨折患者进行回顾性分析。纳入标准为之前接受过半髋关节置换术或髋臼、转子间和转子下骨折切开复位内固定术的患者，由于创伤后关节炎进展为 THA 转换，在转换前有红细胞沉降率/ C 反应蛋白（CRP）。感染定义为术中培养阳性，经感染病会诊后认为不是污染菌，或术后 1 年内发生假体周围关节感染。
12 例（14%）接受 THA 转换的患者发生感染。与非感染组相比，感染组的红细胞沉降率（37.2 比 24.4 mm/h，P=0.2062）和 CRP（22.4 比 9.0 mg/L，P=0.0026）均升高。CRP 的最佳截断值为 12 mg/L（曲线下面积为 0.77，95%置信区间为 0.58-0.97），在整个队列中具有 75%的敏感性、84%的特异性、43%的阳性预测值和 95%的阴性预测值（P<0.0001）。
即使没有临床症状和体征，接受髋关节/髋臼骨折内固定术的患者行 THA 转换仍存在发生假体周围关节感染的高风险。所有接受 THA 转换的患者都应在术前测量 CRP，作为潜在感染诊断的一部分。应进一步研究制定包括 CRP 在内的术前诊断算法，类似于肌肉骨骼感染学会的标准，专门用于接受 THA 转换的患者。
三级，诊断性回顾性队列研究。
