Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland.
Arch Orthop Trauma Surg. 2023 Jul;143(7):4077-4084. doi: 10.1007/s00402-022-04716-7. Epub 2022 Nov 30.
It is unclear whether there is a difference in the incidence of postoperative fever (POF) between hip, knee and shoulder arthroplasty. The influence of a trauma setting has not been investigated.
A retrospective review was performed on 675 joint replacement surgeries (hip, knee, shoulder arthroplasty) in an elective or trauma setting over a 2 year period (2016-2018). Patient demographics and perioperative/postoperative parameters were investigated. The fever curve was characterized. The results and costs of any fever-related diagnostic workup were reviewed.
A total of 89 patients (13.2%) experienced a POF ≥ 38.0 °C, only 21 patients (3.1%) a POF ≥ 38.5 °C (of the latter: 4.6% of hip arthroplasties, 0.6% of knee arthroplasties, 0% of shoulder arthroplasties). There was a significantly greater risk (OR 3.88) for POF ≥ 38.5 °C in trauma total hip arthroplasty (THA) compared to elective THA (10.6 vs. 3.0%; p < 0.01). Differences in POF rate between the various joint areas were statistically insignificant when comparing only elective and trauma cases with each other, even though there was a trend for higher rates in hip surgery. Patients experiencing POF ≥ 38.5 °C were more often males (p < 0.01) and had an increased intraoperative blood loss (p = 0.03) and longer hospital stay (p < 0.01). There was only 1/89 POF patients developing an early periprosthetic joint infection. The cost of a positive fever workup (3/27 patients, 11.1%) leading to a new diagnosis and treatment was 2045 US$.
POF ≥ 38.5 °C was more frequent in traumatic THA compared to elective THA. A trend of difference between POF rates between the different joint areas was statistically insignificant after separating elective and traumatic cases. The risk of developing an early periprosthetic joint infection was not increased in POF. A fever-related diagnostic workup was rarely helpful in the absence of clinical symptoms.
髋、膝、肩关节置换术后发热（POF）的发生率是否存在差异尚不清楚。创伤环境的影响尚未得到调查。
对 2 年间（2016-2018 年）在择期或创伤环境下进行的 675 例关节置换术（髋关节、膝关节、肩关节置换术）进行回顾性分析。调查患者人口统计学和围手术期/术后参数。描述发热曲线。审查任何与发热相关的诊断检查的结果和费用。
共有 89 例（13.2%）患者发生≥38.0°C 的 POF，仅有 21 例（3.1%）患者发生≥38.5°C 的 POF（其中：髋关节置换术 4.6%，膝关节置换术 0.6%，肩关节置换术 0%）。与择期全髋关节置换术（THA）相比，创伤性 THA 中 POF≥38.5°C 的风险显著增加（OR 3.88）（10.6%对 3.0%；p<0.01）。仅比较择期和创伤性病例时，各关节区域的 POF 发生率差异无统计学意义，尽管髋关节手术的发生率呈上升趋势。发生 POF≥38.5°C 的患者多为男性（p<0.01），术中失血量增加（p=0.03），住院时间延长（p<0.01）。仅 1/89 例 POF 患者发生早期假体周围关节感染。阳性发热检查（27 例中的 3 例，11.1%）导致新诊断和治疗的费用为 2045 美元。
与择期 THA 相比，创伤性 THA 中 POF≥38.5°C 更为常见。在将择期和创伤病例分开后，不同关节区域之间 POF 发生率的差异趋势无统计学意义。POF 不会增加早期假体周围关节感染的风险。在没有临床症状的情况下，发热相关的诊断检查很少有帮助。
