Elevated erythrocyte sedimentation rate may not affect stage-two THA, TKA reimplantation
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Erythrocyte sedimentation rate may not be a reliable indicator for timing of stage-two reimplantation for hip and knee arthroplasty, according to recently presented results.
Even if ESR is elevated, C-reactive protein may best identify adequate infection control in periprosthetic joint infection, according to Herrick J. Siegel, MD, who presented findings on stage-two reimplantation at the Musculoskeletal Infection Society Annual Meeting. The meeting was held virtually.
“CRP and ESR are heavily relied upon when deciding whether to proceed with the reimplantation of joint implants,” Siegel said in his presentation. “It is not uncommon for many of us to struggle regarding when the timing of the stage two is optimal,” he said.
“Our questions are two: Is a normal CRP sufficient to proceed with a stage-two reimplantation if ESR remains consistently elevated? And is there a long-term impact on treatment outcomes if ESR remains elevated after the stage-two procedure?” he said.
Between 2011 and 2015, Siegel and colleagues from the division of adult reconstruction and orthopedic oncology at the University of Alabama at Birmingham analyzed 211 patients who were treated with stage-two reconstructions.
“Seventy-seven of these patients had an abnormal ESR at the time of reimplantation and a normal CRP. The remainder of the patients (134 patients) had normal CRP and ESR,” Siegel said. “These two groups were compared in terms of infection control as determined by our infectious disease specialists and clinical reports,” he said.
Siegel and colleagues found 19 patients had recurrent infection of the same joint – four had elevated ESR and 15 had normal ESR at the time of reimplantation. They also found 68 of 72 patients with normal CRP and elevated ESR showed no signs of infection at the last follow-up.
“Patients with elevated ESR at the time of reimplantation were known to have an earlier reinfection than those with normal ESR,” Siegel said. “However, we were unable to show a statistical significance between those who were implanted with normal ESR vs. those with elevated,” he said.
“CRP remains an important indicator of sufficient infection control, particularly useful in the timing of the stage-two reimplantation,” Siegel concluded. “ESR, as mentioned earlier, may be elevated due to other comorbidities and obesity – not a reliable indicator for timing of stage two,” he said.
“Many surgeons remain uncomfortable proceeding with a stage-two procedure if the patient’s ESR remains elevated. Based on our findings, it’s acceptable to proceed if the CRP is normal or close to normal,” Siegel added.
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Siegel HJ, et al. Presentation 21. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 7-8, 2020 (virtual meeting).
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