Pyrexia following total knee replacement

Ghosh, Subhajit; Charity, R.; Haidar, S.G.; Singh, Binod Kumar

doi:10.1016/j.knee.2006.05.001

Cited by 38 publications

(32 citation statements)

References 10 publications

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“…Based on our review, of the 24 positive BC, only 4 were definitively acted upon, 8 were known to be contaminants and the rest were unaccounted for. 1,5,7,11,16,21,28 Other diagnostic studies ranged in yield with BC being on the low end (0-13.3%; inverse variance average 3.5%) and UA being on the high end (8.2-38.7%; inverse variance average 28.5%). Studies were unclear as to whether or not the positive results were acted upon; as such the sensitivity and specificity of these tests are impossible to calculate.…”

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confidence: 99%

“…Febrile events during the first 3 post-operative days, in the absence of localizing symptoms, do not merit a diagnostic workup as they occur in 50-87% of patients. 4,6,7,14,17,20,23 Ishii et al found that post-operative fever in the first 3 days following total joint arthroplasty is exceptionally common. 9 The rate of post-operative fever drops precipitously after that, but does not become zero.…”

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confidence: 99%

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Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Ashley

Spiegel

Cahill

et al. 2017

J Orthop Surg (Hong Kong)

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Background: Defining the appropriate threshold at which to initiate a fever workup is imperative to promote patient safety, appropriate resource utilization, and antibiotic stewardship. Our group performed a systematic review of the available literature on perioperative fever (POF) workups in orthopaedic patients to evaluate the frequency, timing and utility of blood cultures (BC) and other investigations in the POF workup, to determine the clinical relevance of any infections and to evaluate their cost effectiveness. Methods: Studies were identified by searching MEDLINE, EMBASE, Pubmed, Cochrane and Google Scholar for articles through September 2016. Forty-nine articles were retrieved and 22 articles met the pre-determined inclusion criteria. Proportions of positive studies were noted and averaged using random effects analysis. Results: Post-operative pyrexia ranged in prevalence between 8.1% and 87.3%. The studies routinely performed during a fever workup had wide ranges of diagnostic yield, including chest X-rays from 0% to 40%, urinalyses from 8.2% to 38.7%, urine cultures from 0% to 22.4% and BC from 0% to 13.3%. Only two patients with positive BC developed clinical sepsis. Cost per fever evaluation ranged from $350 to $950. Conclusion: The findings of this review suggest that early post-operative fever is an expected event following orthopaedic surgery. Based on the available literature, any kind of workup in the absence of localizing symptoms in the third post-operative day or before is unwarranted and is an inappropriate use of hospital resources.

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confidence: 99%

mentioning

confidence: 99%

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Ashley

Spiegel

Cahill

et al. 2017

J Orthop Surg (Hong Kong)

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“…Fever failed to be a predictive symptom associated to implant infection itself. In the larger study (Ghosh et al 2006 ) retrieved, only 3 % of cases reporting fever during the postoperative period were found to have an infection; instead, about 10 % of cases without fever reported a postoperative infection.…”

Section: Analysis Of the Literature With Critical Discussionmentioning

confidence: 87%

“…The course of procalcitonin levels is different in a Ghosh et al ( 2006 )fever of infectious origin compared with fever of noninfectious origin and thus has to be investigated. On the basis of the fi ndings retrieved from the literature, when fever is present, procalcitonin is a reliable marker for infection and more relevant than CRP for the diagnosis of postoperative infection.…”

Section: Resultsmentioning

confidence: 99%

Perspectives: How to Deal with Fever (38 °C) After Arthroplasty: The Infectivologist’s Point of View

Ascione

Balato

Pagliano

2014

Perioperative Medical Management for Total Joint Arthroplasty

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“…[6,17,[20][21][22][23][24][25], anche se i dati riguardanti la radiologia tradizionale (radiografie ed ecografia) sono molto scarsi e su una serie limitata di pazienti. Non vi sono poi sufficienti studi pubblicati su riviste indicizzate relativi a sensibilità e specificità dei segni e sintomi clinici (solo un lavoro [26] descrive il valore diagnostico dell'iperpiressia nel periodo postoperatorio). I rimanenti studi di buona qualità sono focalizzati su procedure invasive, quali l'aspirazione articolare [2,6,16,17,19,27,28], sull'istologia [2,29,30] e sulle colture intra-operatorie [2,19].…”

Section: Ricerca Bibliograficaunclassified

Diagnostica combinata e nuove prospettive

Romanò

Bonora

et al. 2009

LO SCAL

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IntroduzioneLa chirurgia protesica è una procedura di successo, con più di 120.000 impianti all'anno in Italia. Tuttavia l'infezione rimane una complicanza potenzialmente devastante e costosa. Tale evenienza si verifica mediamente nell'1-2% dei casi, sebbene sia stato riportato che in pazienti a rischio puòmanifestarsi anche nel 12,4% dei casi [1][2][3][4][5]. La diagnosi differenziale tra protesi articolari infette e mobilizzazioni asettiche può essere difficile, poiché nessuno dei test oggi disponibili presenta una sensibilità e specificità del 100%. Mentre, infatti, una infezione acuta si presenta generalmente con sintomi e segni facilmente interpretabili e addirittura banali, la diagnosi delle infezioni subacute, a basso grado di virulenza, è molto più problematica. L'esame clinico, gli esami di laboratorio e le tecniche di immagine, l'agoaspirazione e anche gli esami istologici estemporanei al congelatore sono tutti gravati da una percentuale variabile di falsi positivi e di falsi negativi [6-10].La difficoltà diagnostica può ritardare un adeguato trattamento o portare a cure inappropriate. La mobilizzazione protesica asettica può, infatti, essere trattata efficacemente con una revisione in un tempo, mentre l'infezione protesica richiede quasi sempre procedure medico-chirurgiche più complicate e complesse [11]. In ambito clinico, al fine di ridurre il rischio di errori diagnostici, si usano frequentemente più esami e test, attuando un processo diagnostico che porta all'esito finale attraverso una valutazione combinata delle diverse indagini. Si osserva, tuttavia, che, mentre vengono proposti nuovi e più sofisticati (e costosi) test diagnostici, la scelta e la valutazione dei vari test, effettuati in un dato paziente, è legata a un processo di valutazione soggettiva da parte di ogni singolo chirurgo, quando addirittura non dipende da considerazioni logistiche e/o economiche. Obiettivo del nostro studio è stato quello di valutare in modo prospettico l'efficacia di un sistema automatizzato di calcolo di più test diagnostici indipendenti, comparandolo con il "gold standard" dei test intra-operatori, nel LO SCALPELLO (2009) 23:160-165 ABSTRACT -COMBINED DIAGNOSIS AND NEW PERPECTIVES Based on known sensitivity and specificity of commonly used diagnostic tests for prosthetic infections, we developed the "Combined Diagnostic Tool" (CDT), a software that calculates the overall output of a series of independent tests ("Combined Tests Index", CTI). A CTI >1 indicates a progressively higher chance of prosthetic infection and vice versa. This double-blind, prospective study, comparing CTI to intra-operative culture and histological findings, showed a mean CTI of 711 ± 1298 in infected (N=21) compared to 0.074 ± 0.099 in non-infected patients (N=15) (p = 0.04). CDT is a useful software for differential diagnosis of prosthetic infection.

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Pyrexia following total knee replacement

Cited by 38 publications

References 10 publications

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Perspectives: How to Deal with Fever (38 °C) After Arthroplasty: The Infectivologist’s Point of View

Diagnostica combinata e nuove prospettive

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