Factors Associated With Elevated Inflammatory Markers Prior to Shoulder Arthroplasty

Background: Preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) ranges for several shoulder arthroplasty indications are not well understood. Purpose: We sought to compare preoperative ESR and CRP values for a variety of shoulder arthroplasty indications and evaluate risk factors for elevated preoperative ESR and CRP values. Methods: We conducted a retrospective cohort study of shoulder arthroplasty cases performed at a single academic medical institution from 2013 to 2018. Preoperative ESR and CRP values for 235 shoulder arthroplasties with various indications were recorded. Independent risk factors for elevated values (CRP > 10.0 mg/L and ESR > 30.0 mm/h) were determined via multiple variable logistic regression. Results: Patients undergoing shoulder arthroplasty for osteoarthritis had an ESR (mean ± SD) of 22.6 ± 17.8, with 29.8% of patients elevated, and a CRP of 6.5 ± 6.4, with 25.5% of patients elevated. Arthroplasty for acute fracture and prosthetic joint infection (PJI) had higher preoperative ESR and CRP values. Multivariate analysis identified several predictors of elevated ESR, including infection, acute fracture, diabetes, and female sex. It also identified predictors of elevated CRP, including infection, acute fracture, and younger age. Conclusions: Preoperative ESR and CRP values may be elevated in 25% to 30% of patients undergoing primary shoulder arthroplasty. Arthroplasty for both acute fracture and PJI, along with several other patient factors, was associated with elevated preoperative ESR and CRP. Thus, routine collection of ESR and CRP preoperatively may not be of benefit, as elevated values are common. Further study is warranted.

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The risk of early infection following intra-articular corticosteroid injection following shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/1758573220925817 ◽

2020 ◽

pp. 175857322092581

Author(s):

Jourdan M Cancienne ◽

Brian C Werner

Keyword(s):

Shoulder Arthroplasty ◽

Periprosthetic Infection ◽

Corticosteroid Injection ◽

Joint Infection ◽

Early Infection ◽

Control Group ◽

Prosthetic Joint ◽

Shoulder Arthroplasties ◽

Procedure Type ◽

Corticosteroid Injections

Background There is little literature examining the association of corticosteroid injections into shoulders with a pre-existing arthroplasty. The aim of the current study was to determine the risk of early infection following intra-articular corticosteroid injection into a pre-existing shoulder arthroplasty. Methods The PearlDiver database was retrospectively reviewed to identify patients with a pre-existing shoulder arthroplasty from 2007 to 2017. Patients with an ipsilateral shoulder corticosteroid injection in the postoperative period were identified. A control group of patients without an injection was matched 4:1 by age, gender, and postoperative timepoint. Periprosthetic infection within six months after the injection was then assessed and compared using a logistic regression analysis. Results Nine hundred and fifty-eight patients were identified who underwent a postoperative corticosteroid injection into a pre-existing shoulder arthroplasty and compared to 3832 control patients. After controlling for demographics, comorbidities, and procedure type, the rate of infection in patients who received a postoperative corticosteroid injection (1.77%) was significantly higher than control patients who did not receive an injection (0.91%) (OR 1.98 (95% CI 1.31–2.98), p = 0.0253). Conclusions There is a significant association between intra-articular shoulder corticosteroid injections in patients with pre-existing shoulder arthroplasties and prosthetic joint infection compared to matched controls without postoperative injections. Study Design Level III, retrospective cohort study.

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Risk Factors for Fungal Prosthetic Joint Infection

Journal of Bone and Joint Infection ◽

10.7150/jbji.40402 ◽

2020 ◽

Vol 5 (2) ◽

pp. 76-81

Author(s):

Talha Riaz ◽

Aaron J. Tande ◽

Lisa L. Steed ◽

Harry A. Demos ◽

Cassandra D. Salgado ◽

...

Keyword(s):

Risk Factors ◽

Candida Albicans ◽

Clinical Characteristics ◽

Joint Infection ◽

Management Strategies ◽

Retrospective Case ◽

Wound Drainage ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Independent Risk Factors

Abstract. Background: Fungal prosthetic joint infections (PJIs) are rare and often associated with poor outcome; however, risk factors are not well described.Methods: This was a retrospective case control study among all patients with PJIs from 2006-2016 at two major academic centers. Each fungal PJI case was matched 1:1 with a bacterial PJI control by joint (hip, knee, shoulder) and year of diagnosis. We compared demographics, comorbidities, and clinical characteristics between cases and controls using chi square/Fisher's exact or Wilcoxon rank sum test. Independent risk factors were identified with multivariable logistic regression.Results: Forty-one fungal PJIs occurred over the study and 61% were due to Candida albicans. The hip was involved in 51.2% of cases, followed by the knee (46.3%). Compared to bacterial PJI, fungal PJI cases were more likely to have received antibiotics within the previous 3 months (70.7% vs 34%, P=.001), wound drainage lasting >5 days (48% vs 9%, P=.0002), had a lower median CRP (2.95 mg/dl vs 5.99, P=.013) and synovial fluid white blood cell count (13,953 cells/mm3 vs 33,198, P=.007), and a higher proportion of prior two-stage exchanges (82.9% vs 53.6%, P=.008). After controlling for center, prolonged wound drainage (OR, 7.3; 95% CI, 2.02-26.95) and recent antibiotics (OR, 3.4; 95% CI, 1.2-9.3) were significantly associated with fungal PJI.Conclusion: In our study, Candida albicans was the most common species in fungal PJIs and prolonged wound drainage and recent antibiotics were independent risk factors. These clinical characteristics may help providers anticipate fungal PJI and adjust management strategies.

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Hyperglycemia, hyperadiposity and leukocytosis are independent risk factors for higher serum C‐reactive protein in free‐living adults

The FASEB Journal ◽

10.1096/fasebj.26.1_supplement.819.23 ◽

2012 ◽

Vol 26 (S1) ◽

Author(s):

Fernando Moreto ◽

Rodrigo Minoru Manda ◽

Gabriel Augusto Torezan ◽

Okesley Teixeira ◽

Roberto Carlos Burini

Keyword(s):

Risk Factors ◽

C Reactive Protein ◽

Free Living ◽

Reactive Protein ◽

Independent Risk Factors

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Risk Factors for Prosthetic Joint Infection after Primary Hip Arthroplasty

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2020-26-1-40-47 ◽

2020 ◽

Vol 26 (1) ◽

pp. 40-47

Author(s):

A. A. Myasoedov ◽

S. S. Toropov ◽

G. V. Berezin ◽

V. V. Karelkin ◽

Z. A. Totoev ◽

...

Keyword(s):

Risk Factors ◽

Hip Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Prosthetic Joint ◽

Primary Hip Arthroplasty

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Thromboprophylaxis and haematomas

Pathways in Prosthetic Joint Infection ◽

10.1093/med/9780198791881.003.0004 ◽

2018 ◽

pp. 23-26

Author(s):

Umraz Khan ◽

Graeme Perks ◽

Rhidian Morgan-Jones ◽

Peter James ◽

Colin Esler ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Joint Infection ◽

Joint Arthroplasty ◽

Surgical Patients ◽

Vein Thrombosis ◽

Prosthetic Joint ◽

Deep Vein ◽

Haematoma Formation ◽

Prolonged Surgery

This chapter discusses thromboprophylaxis and haematomas within periprosthetic joint infection. The issue of venous thromboembolism is important for all surgical patients and, as such, those undergoing arthroplasty must undergo a careful and accurate risk assessment. Prolonged surgery and delayed postoperative mobilization are risk factors and are common to most major joint arthroplasty. Use of prophylactic agents to prevent thrombosis must be balanced with the avoidance of haematoma formation as the latter contributes to a risk of prosthetic joint infection. Should deep vein thrombosis occur then swift methods of diagnosis and treatment must be in place.

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Is Gram staining still useful in prosthetic joint infections?

Journal of Bone and Joint Infection ◽

10.7150/jbji.31312 ◽

2019 ◽

Vol 4 (2) ◽

pp. 56-59 ◽

Cited By ~ 1

Author(s):

Marjan Wouthuyzen-Bakker ◽

Noam Shohat ◽

Marine Sebillotte ◽

Cédric Arvieux ◽

Javad Parvizi ◽

...

Keyword(s):

Revision Surgery ◽

Joint Infection ◽

Individual Case ◽

Gram Stain ◽

Reactive Protein ◽

Joint Infections ◽

Gram Staining ◽

Causative Microorganism ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Abstract. Introduction: Staphylococcus aureus is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute S. aureus PJI.Material and methods: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to S. aureus. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.Results: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).Conclusion: Gram staining may be a useful diagnostic tool in late acute PJI to identify S. aureus PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.

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Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study

Journal of Bone and Joint Infection ◽

10.7150/jbji.42076 ◽

2020 ◽

Vol 5 (2) ◽

pp. 89-95 ◽

Cited By ~ 2

Author(s):

Pascale Bémer ◽

Céline Bourigault ◽

Anne Jolivet-Gougeon ◽

Chloé Plouzeau-Jayle ◽

Carole Lemarie ◽

...

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Serological Test ◽

Bacterial Species ◽

Joint Infection ◽

C Reactive Protein ◽

Reactive Protein ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Cutibacterium Acnes

Abstract. Introduction: The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening.Methods: We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (Staphylococcus aureus, S. epidermidis, S. lugdunensis, Streptococcus agalactiae, Cutibacterium acnes) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines.Results: Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; S. agalactiae, 1; C. acnes, 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for S. agalactiae and 83.8% /96.9% for C. acnes.Conclusions: The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.

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