The Use of Preoperative Crp and Esr as Predictive Markers of Prosthetic Joint Infection in Primary Total Hip and Knee Arthroplasty

Abstract

Abstract Title: The Use of Preoperative CRP and ESR as Predictive Markers of Prosthetic Joint Infection in Primary Total Hip and Knee Arthroplasty Background Total hip (THA) and total knee (TKA) arthroplasty are two of the most performed orthopedic surgeries each year in the United States. Prosthetic joint infection (PJI) remains one of the most common serious complications among all patients undergoing total joint arthroplasty (TJA). There has been a significant amount of literature on the use of c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in the field of TJA, specifically for the diagnosis of PJI. However, there is much less data focused on the use of preoperative CRP and ESR in the setting of primary TJA. The purpose of this study was to further investigate any correlation that exists between preoperative CRP/ESR and PJI in primary TJA. Methods All patients of one of two surgeons who underwent primary THA or TKA between 2016 and 2020 at the same institution were identified and studied via a retrospective chart review. After exclusion criteria, 806 patients were included in the final cohort for analysis. Positive CRP was set at >0.3 mg/dL and ESR as >30 mm/hr. Results In our current study, which is the second-largest cohort to date that looks at preoperative inflammatory markers before primary TJA, we found no statistically significant correlation between pre-operative CRP or ESR and PJI. We did find that a higher proportion of patients with PJI had elevated preoperative CRP (70.6%) vs those with normal CRP (29.4%). However, among patients with no PJI, the preoperative CRP was still found to be elevated in half of all patients (49.7%). Conclusion This study is unable to validate the use of preoperative CRP/ESR as a predictive measure of future risk of PJI in primary total joint arthroplasty. However, it does provide quantitative insight into the prevalence of elevated preoperative inflammatory markers in all patients prior to TJA with a considerable proportion of patients having modifiable risk factors. Since there is such a large proportion of patients with elevated inflammatory markers that do not go on to develop PJI, we do not recommend cancellation of TJA unless there is an obvious identified modifiable risk factor that puts them at increased risk of PJI.