Choi Byung-Chan, Min Byung-Woo, Lee Kyung-Jae
Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
Arthroplast Today. 2025 Mar 22;33:101669. doi: 10.1016/j.artd.2025.101669. eCollection 2025 Jun.
Abnormal inflammatory marker levels are often detected in patients who have multiple comorbidities before primary total hip arthroplasty (THA) without a specific infection. This study aimed to examine the prevalence of the elevation of inflammatory markers, distribution of inflammatory markers, and factors affecting the elevation of inflammatory marker levels before primary THA.
A retrospective review of 511 THA cases from the outpatient clinic of a single institution was conducted. Patients were divided into 2 groups with normal (group A: n = 432) vs abnormal (group B: n = 79) C-reactive protein (CRP) values using threshold for the upper limit of normal of 0.5 mg/dL. Preoperative diagnoses and underlying diseases of the patients were reviewed. Underlying diseases and medical history included autoimmune inflammatory disease; diabetes mellitus; chronic kidney disease; histories of cancer, organ transplantation, and contralateral hip arthroplasty; and preoperative urinalysis. The distribution of inflammatory markers, prevalence of preoperative diagnosis, and underlying diseases were compared.
The prevalence of elevated CRP levels was 15.5%. Mean values of all inflammatory markers were significantly lower in group A. The risk of elevated CRP was higher with osteonecrosis of the femoral head (ONFH) and subchondral insufficiency fracture of the femoral head (SIFFH) compared to hip arthritis (ONFH: odds ratio = 3.03; SIFFH: odds ratio = 4.85). The prevalence of autoimmune inflammatory disease was higher in group A than in group B. No difference in the prevalence of other underlying diseases was observed between the groups.
Elevated inflammatory markers are commonly observed before primary THA. Although the distribution of inflammatory markers was different, only CRP level was different based on normal range. Regarding preoperative diagnosis, ONFH and SIFFH significantly influenced the elevation of inflammatory marker levels compared to hip arthritis. Regarding underlying diseases, autoimmune inflammatory disease was the only significant factor affecting the elevation of inflammatory markers.
在初次全髋关节置换术（THA）前患有多种合并症但无特定感染的患者中，常检测到异常的炎症标志物水平。本研究旨在探讨初次THA前炎症标志物升高的患病率、炎症标志物的分布以及影响炎症标志物水平升高的因素。
对单个机构门诊的511例THA病例进行回顾性研究。使用正常上限阈值0.5mg/dL，将患者分为C反应蛋白（CRP）值正常（A组：n = 432）与异常（B组：n = 79）的两组。回顾患者的术前诊断和基础疾病。基础疾病和病史包括自身免疫性炎症性疾病、糖尿病、慢性肾病、癌症病史、器官移植史、对侧髋关节置换史以及术前尿液分析。比较炎症标志物的分布、术前诊断的患病率和基础疾病。
CRP水平升高的患病率为15.5%。A组所有炎症标志物的平均值显著更低。与髋关节炎相比，股骨头坏死（ONFH）和股骨头软骨下不全骨折（SIFFH）患者CRP升高的风险更高（ONFH：比值比 = 3.03；SIFFH：比值比 = 4.85）。A组自身免疫性炎症性疾病的患病率高于B组。两组之间其他基础疾病的患病率无差异。
初次THA前常见炎症标志物升高。尽管炎症标志物的分布不同，但仅CRP水平根据正常范围有所不同。关于术前诊断，与髋关节炎相比，ONFH和SIFFH显著影响炎症标志物水平的升高。关于基础疾病，自身免疫性炎症性疾病是影响炎症标志物升高的唯一重要因素。
