Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, Beijing, China.
Department of Orthopaedics, Shengli Oilfield Central Hospital, Dongying, China.
ANZ J Surg. 2020 Jun;90(6):1062-1066. doi: 10.1111/ans.15915. Epub 2020 May 17.
Serum C-reactive protein (CRP) has been one of the most commonly used markers to rule out early post-operative infection following total joint arthroplasty. The phenomenon that CRP values rise after prolonged drainage removal may occur in clinical settings. The purpose of this study is to investigate (i) the prevalence and risk factors of such a phenomenon and (ii) whether the raised CRP is associated with post-operative infection.
A retrospective review of 72 revision arthroplasties of the knee and hip with prolonged drainage from 2011 to 2016 was conducted. Perioperative CRP levels were obtained, and patients were divided into two groups according to whether CRP levels were elevated after drainage removal (raised CRP group and control group). Multivariate logistic regression analyses were performed to identify risk factors of raised CRP after drainage removal. The incidence of post-operative wound complications and infection was compared between groups.
Overall, the prevalence of raised CRP after drainage removal was 29.17% (21/72). CRP level before drainage removal was associated with the occurrence of such a phenomenon (adjusted odds ratio per 10-mg/L increase 0.92, 95% confidence interval 0.87-0.97). The raised CRP levels decrease again within 3 days after drainage removal. There was no significant difference in the incidence of wound complications and infection between the raised CRP group and control group.
Almost one in three patients have raised CRP values after prolonged drainage removal following revision arthroplasty. However, CRP values can decrease again within 3 days after drainage removal without specific management. Almost one in three patients have raised C-reactive protein values after prolonged drainage removal following revision arthroplasty. However, C-reactive protein values can decrease again within 3 days after drainage removal without specific management. Surgeons should remember that such a phenomenon may be not be a proxy for post-operative infection following revision arthroplasty.
血清 C-反应蛋白（CRP）一直是排除全关节置换术后早期术后感染最常用的标志物之一。在临床实践中，可能会出现 CRP 值在长时间引流后升高的现象。本研究旨在探讨（i）这种现象的发生率和危险因素，以及（ii）升高的 CRP 是否与术后感染有关。
回顾性分析了 2011 年至 2016 年间 72 例膝关节和髋关节翻修术伴长时间引流的患者。获得围手术期 CRP 水平，并根据引流管拔除后 CRP 水平是否升高将患者分为两组（升高 CRP 组和对照组）。采用多因素逻辑回归分析确定引流管拔除后 CRP 升高的危险因素。比较两组术后伤口并发症和感染的发生率。
总体而言，引流管拔除后 CRP 升高的发生率为 29.17%（21/72）。引流前 CRP 水平与该现象的发生有关（每增加 10mg/L 的调整优势比为 0.92，95%置信区间为 0.87-0.97）。升高的 CRP 水平在引流管拔除后 3 天内再次下降。升高 CRP 组和对照组之间的伤口并发症和感染发生率无显著差异。
几乎每 3 名接受翻修关节置换术的患者中就有 1 名在长时间引流后 CRP 值升高。然而，CRP 值在引流管拔除后 3 天内可再次下降，无需特殊治疗。几乎每 3 名接受翻修关节置换术的患者中就有 1 名在长时间引流后 CRP 值升高。然而，CRP 值在引流管拔除后 3 天内可再次下降，无需特殊治疗。外科医生应记住，这种现象可能不是翻修关节置换术后感染的替代指标。
