BACKGROUND: Implant-associated infection (IAI) is a potential complication following total hip (THA) or knee arthroplasty (TKA). The initial phase of the inflammatory process can be measured by applying one of the inflammatory blood parameters (IBP). This systematic review aims to assess the response of IBP to trauma caused by orthopedic surgery and evaluate the clinical utility of quantitative measurements of IBP as prognostic factors for infection. METHODS: All studies indexed in Ovid MEDLINE (PubMed), Ovid EMBASE, the Cochrane Library and the ISI Web of Science databases, from inception until January 31, 2020, were analyzed. Studies included were those on adults who underwent THA or TKA with minimum follow up of 30 days after surgery. In addition to minimum follow up, data on the prognostic factors for pre- or post-THA/TKA IAI were mandatory. The Quality Assessment of Diagnostic Accuracy tool (version 2) (QUADAS-2) and Standards for Reporting of Diagnostic Accuracy Studies guideline 2015 (STARD) were used for quality assessment. RESULTS: Twelve studies fulfilled the inclusion and exclusion criteria. C-reactive protein was analyzed in seven studies, interleukin-6 in two studies and erythrocyte sedimentation rate in eight studies. White blood cell count and procalcitonin were analyzed in the only study. The overall quality of included studies was low. A potential for other cytokines (IL-1ra, IL-8) or MCP-1 was observed. CONCLUSIONS: This is the first systematic review of IBP response to orthopedic surgery which identified some IBP for pre/post-operative screening, despite insufficient data supporting their prognostic potential for patient risk stratification.

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Kralove Charles University Ak Heyrovskeho 1203 8 500 05 Hradec Kralove Czech Republic

Zobrazit více v PubMed

Fu K, Robbins SR, McDougall JJ. Osteoarthritis: the genesis of pain. Rheumatology (Oxford) 2018;57(suppl_4):iv43–iv50. doi: 10.1093/rheumatology/kex419. PubMed DOI

Grayson CW, Decker RC. Total joint arthroplasty for persons with osteoarthritis. PM R. 2012;4(5 Suppl):S97–103. doi: 10.1016/j.pmrj.2012.02.018. PubMed DOI

Hunter D, Pietro-Alhambra D, Arden N. Osteoarthritis: the facts. 2. Oxford: Oxford University Press; 2014.

Loeser RF, Collins JA, Diekman BO. Ageing and the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(7):412–420. doi: 10.1038/nrrheum.2016.65. PubMed DOI PMC

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish ND, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 2013;70:195–283. doi: 10.2146/ajhp120568. PubMed DOI

Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, Kyaw MH. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One. 2013;8(12):e83743. 10.1371/journal.pone.0083743. PubMed PMC

ACS NSQIP Surgical Risk Calculator. In: ACS. Accessed 02 23 2023. Available from: https://riskcalculator.facs.org/RiskCalculator/index.jsp.

Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):152S–157S. doi: 10.1016/0002-9343(91)90361-Z. PubMed DOI

Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, Meghani M, Akhtar M, Costantino T. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013;11(1):55–59. doi: 10.1586/erc.12.159. PubMed DOI

Majors I, Jagadale VS. Serum interleukin 6 could be a valuable initial diagnostic tool in prosthetic knee joint infections. Eur J Orthop Surg Traumatol. 2019;29(8):1781–1788. doi: 10.1007/s00590-019-02519-y. PubMed DOI

Daryapeyma A, Aarstad HJ, Wahlgren CM, Jonung T. Perioperative cytokine response to infection associated with elective arterial surgery. Vasc Endovascular Surg. 2014;48(2):116–122. doi: 10.1177/1538574413512376. PubMed DOI

Germolec DR, Shipkowski KA, Frawley RP, Evans E. Markers of Inflammation. Methods Mol Biol. 1803;2018:57–79. PubMed

Lowsby R, Gomes C, Jarman I, Lisboa P, Nee PA, Vardhan M, Eckersley T, Saleh R, Mills H. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department. Emerg Med J. 2015;32(7):531–534. doi: 10.1136/emermed-2014-204071. PubMed DOI

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. BMJ. 2009;2009(339):b2535. doi: 10.1136/bmj.b2535. PubMed DOI PMC

Domecky P, RejmanPatkova A, Mala-Ladova K, Maly J. Inflammatory blood parameters as prognostic factors for surgical site infection after primary hip or knee arthroplasty: a systematic review protocol. BMJ Open. 2021;11(9):e046027. doi: 10.1136/bmjopen-2020-046027. PubMed DOI PMC

Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, QUADAS-2 Group QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36. doi: 10.7326/0003-4819-155-8-201110180-00009. PubMed DOI

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HC, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF, STARD Group Stard 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527. doi: 10.1136/bmj.h5527. PubMed DOI PMC

Carlsson AS. Erythrocyte sedimentation rate in infected and non-infected total-hip arthroplasties. Acta Orthop Scand. 1978;49(3):287–290. doi: 10.3109/17453677809005766. PubMed DOI

Falzarano G, Piscopo A, Grubor P, Rollo G, Medici A, Pipola V, Bisaccia M, Caraffa A, Barron EM, Nobile F, Cioffi R, Meccariello L. Use of common inflammatory markers in the long-term screening of total hip arthroprosthesis infections: our experience. Adv Orthop. 2017;2017:9679470. PubMed PMC

Forster IW, Crawford R. Sedimentation rate in infected and uninfected total hip arthroplasty. Clin Orthop Relat Res. 1982;168:48–52. doi: 10.1097/00003086-198208000-00008. PubMed DOI

Mulier JC, Desmet L, Martens M, Hoogmartens M. Postoperative infection in total hip replacement. Acta Orthop Belg. 1973;39(3):630–643. PubMed

Mumingjiang Y, Zhou X, He R. Value of knee skin temperature measured by infrared thermography and soluble intercellular adhesion molecule-1 in the diagnosis of peri-prosthetic knee infection in Chinese individuals following total knee arthroplasty. Chin Med J (Engl) 2014;127(17):3105–3109. PubMed

Okafor B, MacLellan G. Postoperative changes of erythrocyte sedimentation rate, plasma viscosity and C-reactive protein levels after hip surgery. Acta Orthop Belg. 1998;64(1):52–56. PubMed

Sanzén L, Sundberg M. Periprosthetic low-grade hip infections. Erythrocyte sedimentation rate and C-reactive protein in 23 cases. Acta Orthop Scand. 1997;68(5):461–5. doi: 10.3109/17453679708996263. PubMed DOI

Sastre S, Soriano À, Garcia S, et al. Serum C-reactive protein as predictor of infected arthroplasty. Eur J Orthop Surg Traumatol. 2006;16:17–19. doi: 10.1007/s00590-005-0035-2. DOI

Shah K, Mohammed A, Patil S, McFadyen A, Meek RM. Circulating cytokines after hip and knee arthroplasty: a preliminary study. Clin Orthop Relat Res. 2009;467(4):946–951. doi: 10.1007/s11999-008-0562-3. PubMed DOI PMC

Windisch C, Brodt S, Roehner E, Matziolis G. The C-reactive protein level after total knee arthroplasty is gender specific. Knee Surg Sports Traumatol Arthrosc. 2016;24(10):3163–3167. doi: 10.1007/s00167-016-4289-5. PubMed DOI

Wroblewski BM. Erythrocyte sedimentation rate and polymethylmethacrylate. J R Coll Surg Edinb. 1974;19(3):182. PubMed

Zarghooni K, Hackenberg RK, Sander G, Mahabir E. Suitability of serum cytokine profiling for early diagnosis of implant-associated infections after orthopaedic surgery: a preliminary prospective study. Cytokine. 2019;116:88–96. doi: 10.1016/j.cyto.2018.12.016. PubMed DOI

Battistelli S, Fortina M, Carta S, Guerranti R, Nobile F, Ferrata P. Serum C-reactive protein and procalcitonin kinetics in patients undergoing elective total hip arthroplasty. Biomed Res Int. 2014;2014:565080. doi: 10.1155/2014/565080. PubMed DOI PMC

Pérez-Prieto D, Portillo ME, Puig-Verdié L, Alier A, Martínez S, Sorlí L, Horcajada JP, Monllau JC. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop. 2017;41(7):1315–1319. doi: 10.1007/s00264-017-3430-5. PubMed DOI

Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754. doi: 10.3389/fimmu.2018.00754. PubMed DOI PMC

Qin L, Li F, Gong X, Wang J, Huang W, Hu N. Combined Measurement of D-Dimer and C-Reactive protein levels: highly accurate for diagnosing chronic Periprosthetic joint infection. J Arthroplasty. 2020;35(1):229–234. doi: 10.1016/j.arth.2019.08.012. PubMed DOI

Yuan K, Li WD, Qiang Y, Cui ZM. Comparison of procalcitonin and C-reactive protein for the diagnosis of periprosthetic joint infection before revision total hip arthroplasty. Surg Infect (Larchmt) 2015;16(2):146–150. doi: 10.1089/sur.2014.034. PubMed DOI

Liu D, Su L, Han G, Yan P, Xie L. Prognostic value of Procalcitonin in adult patients with sepsis: a systematic review and meta-analysis. PLoS One. 2015;10(6):e0129450. doi: 10.1371/journal.pone.0129450. PubMed DOI PMC

Meisner M. Update on procalcitonin measurements. Ann Lab Med. 2014;34(4):263–273. doi: 10.3343/alm.2014.34.4.263. PubMed DOI PMC

Kang KT, Son DW, Lee SH, Song GS, Sung SK, Lee SW. Variation of C-Reactive protein and white blood cell counts in spinal operation: primary fusion surgery versus revision fusion surgery. Korean J Spine. 2017;14(3):66–70. doi: 10.14245/kjs.2017.14.3.66. PubMed DOI PMC

Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR, Infectious Diseases Society of America Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1–e25. doi: 10.1093/cid/cis803. PubMed DOI

Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection Definition of periprosthetic joint infection. J Arthroplasty. 2014;29(7):1331. doi: 10.1016/j.arth.2014.03.009. PubMed DOI

Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450–2. doi: 10.1302/0301-620X.95B11.33135. PubMed DOI

Koh IJ, Cho WS, Choi NY, Parvizi J, Kim TK, Korea Knee Research Group How accurate are orthopedic surgeons in diagnosing periprosthetic joint infection after total knee arthroplasty?: a multicenter study. Knee. 2015;22(3):180–5. doi: 10.1016/j.knee.2015.02.004. PubMed DOI

Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309–1314.e2. doi: 10.1016/j.arth.2018.02.078. PubMed DOI