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Combining C-reactive Protein and Interleukin-6 May Be Useful to Detect Periprosthetic Hip Infection

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The sensitivity and specificity to detect periprosthetic infection of the different methods have been questioned, and no single laboratory test accurately detects infection before revision arthroplasty.

Questions/purposes

We asked whether preoperative C-reactive protein (CRP) and interleukin-6 (IL-6) could lead to similar sensitivity, specificity, and predictive values as our previous results obtained with intraoperative frozen section (FS) in revision total hip arthroplasty (THA).

Methods

We prospectively followed 69 patients who had undergone revision THA for failure of a primary THA. The definitive diagnosis of an infection was determined on the basis of positive histopathologic evidence of infection or growth of bacteria on culture.

Results

Eleven of the 69 hips were infected. The combination of an elevated CRP and IL-6 was correlated with deep infection in all the cases and showed a sensitivity of 0.57 (0.13–1.00), a specificity of 1.00 (0.99–1.00), a positive predictive value of 1.00 (0.87–1.00), and a negative predictive value of 0.94 (0.87–1.00). FS showed a sensitivity of 0.81 (0.54–1.00), a specificity of 0.98 (0.94–1.00), a positive predictive value of 0.90 (0.66–1.00), and a negative predictive value of 0.96 (0.91–1.00). Combining CRP and IL-6 provided similar sensitivity, specificity, and positive predictive values as the FSs.

Conclusions

Our data suggest the combination of CRP and IL-6 would be a useful serologic tool to complement others when diagnosing periprosthetic infection.

Level of Evidence

Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank A. Morandi, MD, and H. García Rivello, MD, for their collaboration on the histologic evaluation.

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Authors and Affiliations

  1. Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Potosí 4215 (C1199ACK), Buenos Aires, Argentina

    Martin A. Buttaro MD, Ignacio Tanoira MD, Fernando Comba MD & Francisco Piccaluga MD

Authors
  1. Martin A. Buttaro MD
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  2. Ignacio Tanoira MD
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  3. Fernando Comba MD
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  4. Francisco Piccaluga MD
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Corresponding author

Correspondence to Martin A. Buttaro MD.

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Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Buttaro, M.A., Tanoira, I., Comba, F. et al. Combining C-reactive Protein and Interleukin-6 May Be Useful to Detect Periprosthetic Hip Infection. Clin Orthop Relat Res 468, 3263–3267 (2010). https://doi.org/10.1007/s11999-010-1451-0

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  • DOI: https://doi.org/10.1007/s11999-010-1451-0

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