Zusammenfassung
Hintergrund
Die Infektion ist eine folgenschwere Komplikation nach primärer Endoprothetik von Hüft- und Kniegelenk. Das C-reaktive Protein (CRP) hat sich als Infektparameter aufgrund seiner hohen Sensitivität etabliert. Bei mäßiger Spezifität ist bislang unklar, ob eine erhöhte CRP-Konzentration ohne begleitende Klinik ein Risikofaktor für die Entwicklung eines Protheseninfekts nach primärer Endoprothetik ist.
Material und Methode
Im Rahmen einer retrospektiven Untersuchung wurden Patienten mit Protheseninfektion nach primärer Hüft- oder Knieendoprothese hinsichtlich Alter, Geschlecht und Nebenerkrankungen mit einem Patientenkollektiv ohne Protheseninfektion gematcht. Das Durchschnittsalter der 50 in die Studie eingeschlossenen Patienten betrug 67,4 (48–81) Jahre. In den Gruppen waren jeweils 8 Männer und 17 Frauen. Neben dem präoperativen CRP wurden die patienten- und operationsbezogenen Daten und die mikrobiologischen und histopathologischen Befunde erhoben.
Ergebnisse
Das durchschnittliche präoperative CRP betrug in der Infektionsgruppe 1,3±2,5 mg/dl gegenüber 0,4±0,7 mg/dl in der Kontrollgruppe. Ein Grenzwert von 0,5 mg/dl diskriminierte am besten zwischen den Untersuchungsgruppen [13/25 (52%) Infektionsgruppe, 3/25 (12%) Kontrollgruppe, p=0,003]. Unabhängig vom Auftreten einer Infektion zeigten Patienten mit Diabetes mellitus in beiden Gruppen signifikant höhere CRP-Werte (1,2±1,5 mg/dl vs. 0,7±2,0mg/dl, p=0,03).
Schlussfolgerung
Ein erhöhtes präoperatives CRP ist auch bei einem unauffälligen klinischen Befund ein Risikofaktor für die Entwicklung eines Protheseninfekts nach primärer Hüft- oder Knieendoprothese mit einem Grenzwert von 0,5 mg/dl. Verantwortlich scheinen latente lokale oder systemische Infektionen oder aseptische Inflammationen mit konsekutiver lokaler Immunsuppression zu sein. Wir empfehlen die Bestimmung des CRP vor jeder Hüft- oder Knieendoprothesenoperation. Werte >0,5 mg/dl sollten durch systemische und lokale Fokussuche abgeklärt werden. Andernfalls ist der Patient über ein erhöhtes Infektionsrisiko aufzuklären.
Abstract
Background
Infection is a severe complication after primary arthroplasty of the hip (THA) or knee joint (TKA). Based on its high sensitivity, the C-reactive protein (CRP) concentration has become a valuable tool in the diagnosis of infection, although it has only moderate specificity. Because of this, it remains unclear whether a preoperative increased CRP without clinical symptoms is a risk factor for infection after primary arthroplasty.
Material and methods
In a retrospective analysis, we investigated individuals with infection after primary THA or TKA and matched them with patients without infection after similar operations. Matching criteria were age, gender, and present diseases. The average age of the 50 included individuals was 67.4 (range 48–81) years, with eight men and 17 women in each group. In addition to preoperative CRP, specific patient and surgery data and microbiological and histopathologic findings were obtained.
Results
The average preoperative CRP concentration in the infected patient group was 1.3±2.5 mg/dl, in contrast to 0.4±0.7 mg/dl in the noninfected group. A threshold of 0.5 mg/dl was appropriate for discriminating between the two groups [13/25 (52%) in the infection group vs. 3/25 (12%) in the control group, p=0.003]. Independent from the patient group, CRP concentrations were significantly increased in individuals with diabetes mellitus (1.2±1.5 vs. 0.7±2.0 mg/dl, p=0.03).
Conclusion
An increased preoperative CRP concentration without clinical findings of infection is a risk factor for prosthetic infection after primary THA or TKA with a threshold concentration of 0.5 mg/dl. Latent local or systemic infections or aseptic inflammation with subsequent local immune suppression seem to be responsible. We recommend evaluating CRP before every THA and TKA. For values beyond 0.5 mg/dl, an exploration for infection should be done. Otherwise, the patient should be informed about the increased risk of infection.
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Pfitzner, T., Krocker, D., Perka, C. et al. Das C-reaktive Protein. Orthopäde 37, 1116–1120 (2008). https://doi.org/10.1007/s00132-008-1342-1
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DOI: https://doi.org/10.1007/s00132-008-1342-1