Predicting the disaster – The role of CRP in acetabular surgery

Saul, Dominik; Hünicke, P.; Böker, Kai Oliver; Spering, Christopher; Maheshwari, Arvind; Acharya, Mehool; Lehmann, Wolfgang

doi:10.1016/j.clinbiochem.2021.04.020

Cited by 5 publications

(7 citation statements)

References 33 publications

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“…While the patients without an infection rarely revealed a second peak, it was more frequent in the patients with infection. The combination of a second peak and failure to decline seemed to be highly predictive in acetabular and spine surgery [29,30], while in this study, we could not confirm these results in primary hip arthroplasties. This may be due to the low numbers (four) in our cohort having a second CRP peak, out of eight patients with a PJI.…”

Section: Discussioncontrasting

confidence: 87%

“…Similarly, our study was able to demonstrate that a postoperative infection after treatment of an acetabular fracture can be detected by the maximum CRP and a second peak with a sensitivity of 83% and a specificity of 81% [29].…”

Section: Discussionsupporting

confidence: 69%

“…With a satisfactory approximation, we calculated the estimated relative CRP values for days 4 and 5 (49.67% and 43.95% of maximum CRP, respectively). Subsequently, we extended the threshold by 15% (resulting in 72.30% and 64.67% on days 4 and 5) [29,30], and were able to determine values as "failure to decline" for days 4 and 5. Resulting sensitivity and specificity were determined.…”

Section: Postoperative Kineticsmentioning

confidence: 99%

“…Next, we assessed the appearance of a second peak ("rise in CRP, which was preceded and followed by lower CRP values"), which was highly predictive in acetabular surgery [29] and spine surgery [30]. The sensitivity and specificity of a second peak were at a low 12.50% and 87.57%, respectively.…”

Section: Second Peak Failure Declinementioning

confidence: 99%

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Predicting the Exception—CRP and Primary Hip Arthroplasty

Meier

Bauer

Maheshwari

et al. 2021

JCM

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Background: While primary hip arthroplasty is the most common operative procedure in orthopedic surgery, a periprosthetic joint infection is its most severe complication. Early detection and prediction are crucial. In this study, we aimed to determine the value of postoperative C-reactive protein (CRP) and develop a formula to predict this rare, but devastating complication. Methods: We retrospectively evaluated 708 patients with primary hip arthroplasty. CRP, white blood cell count (WBC), and several patient characteristics were assessed for 20 days following the operative procedure. Results: Eight patients suffered an early acute periprosthetic infection. The maximum CRP predicted an infection with a sensitivity and specificity of 75% and 56.9%, respectively, while a binary logistic regression reached values of 75% and 80%. A multinominal logistic regression, however, was able to predict an early infection with a sensitivity and specificity of 87.5% and 78.9%. With a one-phase decay, 71.6% of the postoperative CRP-variance could be predicted. Conclusion: To predict early acute periprosthetic joint infection after primary hip arthroplasty, a multinominal logistic regression is the most promising approach. Including five parameters, an early infection can be predicted on day 5 after the operative procedure with 87.5% sensitivity, while it can be excluded with 78.9% specificity.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionsupporting

confidence: 69%

Section: Postoperative Kineticsmentioning

confidence: 99%

Section: Second Peak Failure Declinementioning

confidence: 99%

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Predicting the Exception—CRP and Primary Hip Arthroplasty

Meier

Bauer

Maheshwari

et al. 2021

JCM

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“…The authors concluded that the extended LOS was strongly related to the preoperative abnormal laboratory blood test (e.g., leukocytosis, anemia) and strongly suggested to consider delaying surgery in cases of preoperative leukocytosis. Saul et al[ 22 ] found that CRP was a very good predictor for a postoperative infection; additionally, the elevated CRP peak could also be related to the extent of the surgical trauma, given that the peak of CRP in ORIF was higher than that in minimal invasive. The blood biochemistry analysis of our patient revealed hypoalbuminemia (Table I).…”

Section: Discussionmentioning

confidence: 99%

Bilateral acetabular fracture secondary to high-velocity trauma: A rare case report

Kenmegne

Zou

et al. 2022

Jt Dis Relat Surg

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Bilateral acetabular fractures have long been described in seizure patients, osteoporotic acetabular insufficiency. Few cases have been reported in the context of high-velocity trauma. The bilateral traumatic acetabular fracture is very rare and complex due to the unique nature of the force and the fracture pattern. A 48-year-old female patient was admitted to our orthopedic ward for bilateral acetabular fracture after a road traffic accident. On admission, the patient presented with some associated complications susceptible to influence the prognosis. In conclusion, bilateral acetabular fracture secondary to high-velocity trauma can be successfully managed with open reduction and internal fixation, even in cases with a very high risk of surgical site infection and sepsis.

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