Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty - A prospective evaluation

被引:187
作者
Greidanus, Nelson V. [1 ]
Masri, Bassam A. [1 ]
Garbuz, Donald S. [1 ]
Wilson, S. Darrin [1 ]
McAlinden, M. Gavan [1 ]
Xu, Min [1 ]
Duncan, Clive P. [1 ]
机构
[1] Univ British Columbia, Dept Orthopaed, Div Lower Limb Reconstruct & Oncol, Vancouver, BC V5Z 4E3, Canada
关键词
D O I
10.2106/JBJS.D.02602
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Despite the widespread use of several diagnostic tests, there is still no perfect test for the diagnosis of infection at the site of a total knee arthroplasty. The purpose of this study was to evaluate the diagnostic test characteristics of the erythrocyte sedimentation rate and C-reactive protein level for the assessment of infection in patients presenting for revision total knee arthroplasty. Methods: One hundred and fifty-one knees in 145 patients presenting for revision total knee arthroplasty were evaluated prospectively for the presence of infection with measurement of the erythrocyte sedimentation rate and the C-reactive protein level. The characteristics of these tests were assessed with use of two different techniques: first, receiver-operating-characteristic curve analysis was performed to determine the optimal positivity criterion for the diagnostic test, and, second, previously accepted criteria for establishing positivity of the tests were used. Results: A diagnosis of infection was established for forty-five of the 151 knees that underwent revision total knee arthroplasty. The receiver-operating-characteristic curves indicated that the optimal positivity criterion was 22.5 mm/hr for the erythrocyte sedimentation rate and 13.5 mg/L for the C-reactive protein level. Both the erythrocyte sedimentation rate (sensitivity, 0.93; specificity, 0.83; positive likelihood ratio, 5.81; accuracy, 0.86) and the C-reactive protein level (sensitivity, 0.91; specificity, 0.86; positive likelihood ratio, 6.89; accuracy, 0.88) have excellent diagnostic test performance. Conclusions: The erythrocyte sedimentation rate and the C-reactive protein level provide excellent diagnostic test information for establishing the presence or absence of infection prior to surgical intervention in patients with pain at the site of a knee arthroplasty.
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页码:1409 / 1416
页数:8
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