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Archives of Orthopaedic and Trauma Surgery

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Open Access 30-01-2021 | Acne | Orthopaedic Surgery

The role of serum C-reactive protein in the diagnosis of periprosthetic shoulder infection

Authors: Doruk Akgün, Mats Wiethölter, Paul Siegert, Victor Danzinger, Marvin Minkus, Karl Friedrich Braun, Philipp Moroder

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2022

Abstract

Introduction

There is a paucity of literature regarding serum C-reactive protein (CRP) in the evaluation of a shoulder periprosthetic joint infection (PJI). The purpose of the current study was to establish cutoff values for diagnosing shoulder PJI and evaluate the influence of the type of infecting microorganism and the classification subgroups according to last proposed International Consensus Meeting (ICM) criteria on the CRP level.

Materials and methods

A retrospective analysis of all 136 patients, who underwent septic or aseptic revision shoulder arthroplasty in our institution between January 2010 and December 2019, was performed. Shoulder PJI was defined according to the last proposed definition criteria of the ICM. Serum CRP levels were compared between infected and non-infected cases, between infection subgroups, as well as between different species of infecting microorganisms. A receiver-operating characteristic (ROC) analysis was performed to display sensitivity and specificity of serum CRP level for shoulder PJI.

Results

A total of 52 patients (38%) were classified as infected, 18 meeting the criteria for definitive infection, 26 for probable infection and 8 for possible infection. According to the ROC curve, an optimized serum CRP threshold of 7.2 mg/l had a sensitivity of 69% and specificity of 74% (area under curve = 0.72). Patients with definitive infection group demonstrated significantly higher median serum CRP levels (24.3 mg/l), when compared to probable, possible infection groups and PJI unlikely group (8 mg/l, 8.3 mg/l, 3.6 mg/l, respectively, p < 0.05). The most common isolated microorganism was Cutibacterium acnes in 25 patients (48%) followed by coagulase-negative staphylococci (CNS) in 20 patients (39%). Patients with a PJI caused by high-virulent microorganisms had a significantly higher median serum CRP level compared to patients with PJI caused by low-virulent microorganisms (48 mg/l vs. 11.3 mg/l, p = 0.04).

Conclusions

Serum CRP showed a low sensitivity and specificity for the diagnosis of shoulder PJI, even applying cutoffs optimized by receiver-operating curve analysis. Low-virulent microorganisms and patients with probable and possible infections are associated with lower CRP levels compared to patients with definitive infection and infections caused by high-virulent microorganisms.

Level of evidence

Diagnostic Level III.

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Title: The role of serum C-reactive protein in the diagnosis of periprosthetic shoulder infection
Authors: Doruk Akgün
Mats Wiethölter
Paul Siegert
Victor Danzinger
Marvin Minkus
Karl Friedrich Braun
Philipp Moroder
Publication date: 30-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Acne
Joint Infection
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03779-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The role of serum C-reactive protein in the diagnosis of periprosthetic shoulder infection

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

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