Aseptic loosening of total hip arthroplasty: Infection always should be ruled out

Javad Parvizi, Dong Hun Suh, S. Mehdi Jafari, Adam Mullan, James J. Purtill

Research output: Contribution to journalArticle

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Abstract

Background: It is believed that some cases of aseptic failure of THA may be attributable to occult infections. However, it is unclear whether preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are more likely elevated in these patients than those without overt infection. Questions/purposes: We asked whether some patients with aseptic THA failures have abnormal serologic indicators of periprosthetic joint infection (PJI) at the time of revision, namely ESR and/or CRP. Methods: Three hundred twenty-three revision THAs for aseptic loosening from 2004 to 2007 were retrospectively evaluated. We categorized all cases into two groups: (1) those with overt PJI (n = 14) plus patients who had a positive intraoperative culture during the index revision (n = 13) and (2) those who did not require rerevision (n = 276) or required surgery for noninfected causes (n = 20). Mean and frequency of abnormal ESR and CRP were compared between the two groups. The minimum followup was 11 months (average, 35 months; range, 11-54 months). Results: The mean and frequency of abnormal CRP in first group (n = 27) at 2.1 mg/dL and 48% respectively, were greater than those of the uninfected (n = 296) at 1.2 mg/dL and 27%, respectively. However, there were no differences between two groups regarding mean or frequency of abnormal ESR. Conclusion: Some patients with presumed aseptic loosening may have abnormal serologic indicators of PJI that either have escaped diagnosis or were not adequately investigated. All patients undergoing revision THA should have ESR and CRP measured preoperatively and those with abnormal CRP should have additional evaluations to rule out or confirm PJI. Level of Evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)1401-1405
Number of pages5
JournalClinical Orthopaedics and Related Research
Volume469
Issue number5
DOIs
Publication statusPublished - 2011 May 1

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Arthroplasty
C-Reactive Protein
Blood Sedimentation
Tacrine
Hip
Abnormal Erythrocytes
Joints
Infection
Retrospective Studies
Guidelines

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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Aseptic loosening of total hip arthroplasty : Infection always should be ruled out. / Parvizi, Javad; Suh, Dong Hun; Jafari, S. Mehdi; Mullan, Adam; Purtill, James J.

In: Clinical Orthopaedics and Related Research, Vol. 469, No. 5, 01.05.2011, p. 1401-1405.

Research output: Contribution to journalArticle

Parvizi, Javad ; Suh, Dong Hun ; Jafari, S. Mehdi ; Mullan, Adam ; Purtill, James J. / Aseptic loosening of total hip arthroplasty : Infection always should be ruled out. In: Clinical Orthopaedics and Related Research. 2011 ; Vol. 469, No. 5. pp. 1401-1405.
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abstract = "Background: It is believed that some cases of aseptic failure of THA may be attributable to occult infections. However, it is unclear whether preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are more likely elevated in these patients than those without overt infection. Questions/purposes: We asked whether some patients with aseptic THA failures have abnormal serologic indicators of periprosthetic joint infection (PJI) at the time of revision, namely ESR and/or CRP. Methods: Three hundred twenty-three revision THAs for aseptic loosening from 2004 to 2007 were retrospectively evaluated. We categorized all cases into two groups: (1) those with overt PJI (n = 14) plus patients who had a positive intraoperative culture during the index revision (n = 13) and (2) those who did not require rerevision (n = 276) or required surgery for noninfected causes (n = 20). Mean and frequency of abnormal ESR and CRP were compared between the two groups. The minimum followup was 11 months (average, 35 months; range, 11-54 months). Results: The mean and frequency of abnormal CRP in first group (n = 27) at 2.1 mg/dL and 48{\%} respectively, were greater than those of the uninfected (n = 296) at 1.2 mg/dL and 27{\%}, respectively. However, there were no differences between two groups regarding mean or frequency of abnormal ESR. Conclusion: Some patients with presumed aseptic loosening may have abnormal serologic indicators of PJI that either have escaped diagnosis or were not adequately investigated. All patients undergoing revision THA should have ESR and CRP measured preoperatively and those with abnormal CRP should have additional evaluations to rule out or confirm PJI. Level of Evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.",
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