Atrium Health - Department of Orthopaedics, Charlotte, NC; Atrium Health - Musculoskeletal Institute, Charlotte, NC.
OrthoCarolina Research Institute, Charlotte, NC.
J Arthroplasty. 2022 Feb;37(2):347-352. doi: 10.1016/j.arth.2021.10.028. Epub 2021 Nov 3.
Two-stage exchange is a commonly used approach for treating chronic periprosthetic joint infections (PJI). A pre-reimplantation threshold value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to determine infection eradication and the proper timing of reimplantation remains ill-defined.
We retrospectively reviewed 483 potential patients for eligibility. In total, 178 patients were excluded. In addition, 305 joints were eligible who underwent 2-stage revision for prosthetic hip or knee joint infection (PJI). Serum ESR and CRP were recorded at 8 weeks post resection prior to stage 2 reimplantation. ESR and CRP were analyzed with receiver operating characteristic curves (ROC) for response failure.
In total, 252 patients had resections for chronic infections while 53 septic patients had resections for acute infections. Forty-one of 252 (16.3%) patients failed reimplantation. Median ESR at the time of reimplantation was 17 (normal less than 20 mm/h). Median CRP was 0.6 (normal less than 0.5 mg/dL). ROC plot for response failure in analyzing ESR found an area under the curve (AUC) of 0.47. ROC plot analyzing CRP found an AUC of 0.57. The ratio of ESR/CRP was also utilized and found an AUC of 0.60. All of the AUC data are in the "fail to discriminate category."
Although improvements in serology can be somewhat reassuring, there are no statistically significant values of ESR or CRP that would predict failure of reimplantation in the 2-stage treatment of PJI. Because we are flying blind consideration should be made for mandatory pre-reimplantation aspirates.
Level IV, Retrospective Case Series.
两阶段置换是治疗慢性人工关节周围感染（PJI）的常用方法。红细胞沉降率（ESR）和 C 反应蛋白（CRP）的预再植入阈值来确定感染的消除和适当的再植入时间仍然定义不明确。
我们回顾性地审查了 483 名符合条件的患者。共有 178 名患者被排除在外。此外，305 个关节符合条件，这些关节因人工髋关节或膝关节感染（PJI）接受了两阶段翻修。在第二期再植入前，切除后 8 周记录血清 ESR 和 CRP。使用接受者操作特征曲线（ROC）分析 ESR 和 CRP 以评估治疗反应失败。
共有 252 名患者因慢性感染接受了切除手术，而 53 名败血症患者接受了急性感染的切除手术。252 名患者中有 41 名（16.3%）再植入失败。再植入时的 ESR 中位数为 17（正常小于 20mm/h）。CRP 的中位数为 0.6（正常小于 0.5mg/dL）。分析 ESR 以评估治疗反应失败的 ROC 图发现 AUC 为 0.47。分析 CRP 的 ROC 图发现 AUC 为 0.57。ESR/CRP 比值也被利用，发现 AUC 为 0.60。所有 AUC 数据都属于“无法区分”类别。
尽管血清学的改善可能会有些令人放心，但在两阶段治疗 PJI 中，ESR 或 CRP 没有统计学上显著的数值可以预测再植入的失败。由于我们是盲目飞行，因此应该考虑强制性的再植入前抽吸。
四级，回顾性病例系列。
