Do elevated preoperative serum inflammatory markers influence surgical site or periprosthetic joint infections following primary total hip arthroplasty?

Abstract

Background: We aimed to determine whether elevated preoperative serum inflammatory markers influence surgical site infections (SSIs) and periprosthetic joint infections (PJIs) after primary total hip arthroplasty (THA).

Methods: In this retrospective single-institution study, 1115 patients who underwent primary THA were enrolled. Cases of SSI/PJI were identified. The enrolled patients were classified into three groups: Group 1 [both C-reactive protein (CRP) ≦0.3 mg/dL and erythrocyte sedimentation rate (ESR) ≦20 mm/h], Group 2 (either 0.3 mg/dL < CRP≦1.0 mg/dL or ESR>20 mm/h), and Group 3 (both CRP>1.0 mg/dL and ESR>20 mm/h). Logistic univariate analysis was performed to calculate the hazard ratio for the incidence of SSI/PJI among the three groups. Next, the patients in Group 3 were propensity score-matched with those in Groups 1 and 2 using 1:2 nearest-neighbor matching for age, sex, body mass index, American Society of Anesthesiologists Physical Status, hip disorder etiology, and past history of autoimmune diseases. After matching, we compared the incidence rates of SSIs/PJIs among the three groups.

Results: Overall, 18 cases, including SSI in eight hips (0.7 %) and PJI in 10 hips (0.9 %), were included. Logistic univariate analysis revealed that elevated preoperative ESR and CRP levels were risk factors for SSI/PJI in this cohort (odds ratio 13.5; 95 % confidence interval, 4.19-43.5; P < 0.001). After propensity score-matching for patient factors, the incidence rates of SSI/PJI were four hips (8.9 %) in Group 3, one hip (1.1 %) in Group 1, and four hips (4.4 %) in Group 2. SSI/PJI were more likely to occur in Group 3, although incidence rates were not significant among the groups (P = 0.04).

Conclusion: Elevated preoperative serum inflammatory markers may increase the incidence of SSI/PJI following primary total hip arthroplasty. Surgeons should recognaize patients with C-reactive protein >1.0 mg/dL and erythrocyte sedimentation rate >20 mm/h as high-risk group of SSI/PJI.