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

Abstract

Background: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are inflammatory markers commonly used during the diagnosis and treatment of periprosthetic joint infection (PJI) in arthroplasty patients. The purpose of this study was to assess for a correlation between pre-operative CRP/ESR and post-operative development of PJI in patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) and to assess modifiable and nonmodifiable risk factors in patients with elevated preoperative inflammatory markers.Methods: Retrospective review of 806 patients at a single institution who underwent THA (n = 291) and TKA (n = 515). CRP and ESR were obtained on all patients during the preoperative workup. Patient demographics, medical comorbidities, and occurrence of PJI were extracted. Positive CRP was set at any value > 0.3 mg/dL and positive ESR as any value > 30 mm/hr. Results:In our study, we found no statistically significant correlation between pre-operative CRP or ESR and PJI. Although notably, we found that a higher proportion of patients with PJI had elevated preoperative CRP (70.6%) vs. those with normal CRP (29.4%). Conclusions:This study is unable to validate the use of preoperative CRP/ESR as a predictive measure of PJI in primary THA/TKA. However, it does provide quantitative insight into the prevalence of elevated preoperative CRP/ESR in all patients prior to THA/TKA with a considerable proportion having modifiable risk factors. Since a large proportion of patients with elevated CRP/ESR didn't develop PJI, we do not recommend cancellation of THA/TKA unless there is an obvious modifiable risk factor that confers substantially heightened risk of PJI.