Department of Orthopaedics Surgery, Orthopaedic Research Institute, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.
Core Facilities of West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2022 Nov;14(11):2987-2994. doi: 10.1111/os.13533. Epub 2022 Oct 4.
C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen and D-Dimer are used as diagnostic biomarkers of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). The purpose of the study was to investigate the normal trajectory of CRP, ESR, plasma fibrinogen and D-Dimer at different time points after two-stage exchange arthroplasty for PJI.
We studied 53 patients undergoing two-stage exchange for PJI at five time points: preoperatively (T0), duration of hospital stays (T1), 30 days (T2), 30-90 days (T3), and 90-180 days (T4) after surgery. The medical records of all patients were well documented and carefully reviewed. The Shapiro-Wilk test was utilized to compare the normal distribution for continuous variables, and the nonnormally distributed data were used for Friedmann's one-way repeat measures analysis of variances. Post hoc Dunnett's test was used to compare each pair of data to find differences from baseline.
Compare with T0 point, the levels of CRP and ESR increased significantly and reached peak values at T1 point (all P < 0.001), with median values of 56.40 mg/L (range, 5.54-161.0 mg/L) and 49.00 mm/h (range, 13.00-113.0 mm/h), respectively. In addition, the levels of plasma fibrinogen and D-Dimer increased significantly and reached peak values at T1 point (all P < 0.001), with median values of 4.13g/L (range, 2.27-6.80 mg/L) and 4.00 mg/L (range, 0.19-14.01 mg/L), respectively. CRP and ESR rapidly declined at the T2 point with significantly compared with T0 point (P = 0.001 and P < 0.001). The levels of CRP, ESR, plasma fibrinogen and D-Dimer returned to preoperative levels of 5.23 mg/L (range, 1.01-21.70 mg/L), 19.00 mm/h (range, 6.00-60.00 mm/h), 3.38g/L (range, 1.71-5.10 g/L) and 2.33 mm/h (range, 0.19-6.87 mg/L) at T4 point, and there was no significant difference compared with T0 point (all P > 0.05).
The study demonstrated the normal trajectory of CRP, ESR, plasma fibrinogen and D-Dimer at five time points in patients who underwent two-stage exchange for PJI. Thus, the results have the possibility of providing signs of infection after the patient receives two-stage exchange arthroplasty for PJI, which can benefit from early treatment.
C 反应蛋白（CRP）、红细胞沉降率（ESR）、血浆纤维蛋白原和 D-二聚体已被用作全关节置换术后假体关节感染（PJI）的诊断生物标志物。本研究旨在探讨 PJI 行两阶段关节置换术后不同时间点 CRP、ESR、血浆纤维蛋白原和 D-二聚体的正常变化轨迹。
我们研究了 53 例因 PJI 行两阶段关节置换术的患者，在五个时间点进行研究：术前（T0）、住院时间（T1）、30 天（T2）、30-90 天（T3）和 90-180 天（T4）。所有患者的病历均记录完整，并进行了仔细审查。 Shapiro-Wilk 检验用于比较连续变量的正态分布，非正态分布数据采用 Friedman 单向重复测量方差分析。Dunnett 事后检验用于比较每对数据与基线的差异。
与 T0 点相比，CRP 和 ESR 水平显著升高，并在 T1 点达到峰值（均 P<0.001），中位数分别为 56.40 mg/L（范围 5.54-161.0 mg/L）和 49.00 mm/h（范围 13.00-113.0 mm/h）。此外，血浆纤维蛋白原和 D-二聚体水平显著升高，并在 T1 点达到峰值（均 P<0.001），中位数分别为 4.13g/L（范围 2.27-6.80 mg/L）和 4.00 mg/L（范围 0.19-14.01 mg/L）。CRP 和 ESR 在 T2 点迅速下降，与 T0 点相比有显著差异（P=0.001 和 P<0.001）。CRP、ESR、血浆纤维蛋白原和 D-二聚体在 T4 点恢复至术前水平，分别为 5.23 mg/L（范围 1.01-21.70 mg/L）、19.00 mm/h（范围 6.00-60.00 mm/h）、3.38g/L（范围 1.71-5.10 g/L）和 2.33 mm/h（范围 0.19-6.87 mg/L），与 T0 点相比无显著差异（均 P>0.05）。
本研究在 53 例因 PJI 行两阶段关节置换术的患者中，检测了 CRP、ESR、血浆纤维蛋白原和 D-二聚体在五个时间点的正常变化轨迹。因此，这些结果有可能为患者接受 PJI 两阶段关节置换术后感染提供感染迹象，从而有利于早期治疗。
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