C-Reactive Protein as a Predictor of the Success of Debridement, Antibiotics and Implant Retention in Patients With Periprosthetic Joint Infection: A 17-year Retrospective Study of 2 Major Joint Arthroplasty Centers.

BACKGROUND

This retrospective study aims to investigate whether C-reactive protein (CRP) value following debridement, antibiotics, and implant retention (DAIR) procedure is a sensitive and specific marker to monitor the clinical course and predict the outcome of the DAIR procedure.

METHODS

The electronic clinical management system was used to identify patients who suffered from the first episode of periprosthetic joint infection (PJI) following a total hip or knee arthroplasty and 2) and received DAIR as their first surgical treatment in 2 tertiary hospitals.

RESULTS

Sixty-five patients were included in this study. Mean age was 68.5 and 55.7% were female. Mean follow-up duration was 3.31 years. 42 (64.6%) patients had successful DAIR while 23 (35.4%) had failed DAIR. Statistical analysis was carried out. Patients with PJI within 3 months from initial arthroplasty, infected by organism without drug resistance, and symptom onset within 3 days, and who could achieve a CRP cutoff at 5 mg/dL by 2 weeks, were significantly more likely to have successful DAIR ( = .037). The area under the curve was 0.892 (95% confidence interval: 0.811-1.000). Patients with PJI more than 3 months after the initial operation were 24.9 times more likely to fail DAIR after adjustments ( = .019).

CONCLUSIONS

This is the first study to report a CRP cutoff at 5 mg/dL at 2 weeks was able to assist in identifying patients at higher risk of failure following DAIR procedure.