title: Aseptic loosening of total hip arthroplasty: infection always should be ruled out.
abstract: BACKGROUND
  It is believed that some cases of aseptic failure of THA may be attributable to occult infections. However, it is unclear whether preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are more likely elevated in these patients than those without overt infection.
  
  
  OBJECTIVE
  We asked whether some patients with aseptic THA failures have abnormal serologic indicators of periprosthetic joint infection (PJI) at the time of revision, namely ESR and/or CRP.
  
  
  METHODS
  Three hundred twenty-three revision THAs for aseptic loosening from 2004 to 2007 were retrospectively evaluated. We categorized all cases into two groups: (1) those with overt PJI (n = 14) plus patients who had a positive intraoperative culture during the index revision (n = 13) and (2) those who did not require rerevision (n = 276) or required surgery for noninfected causes (n = 20). Mean and frequency of abnormal ESR and CRP were compared between the two groups. The minimum followup was 11 months (average, 35 months; range, 11-54 months).
  
  
  RESULTS
  The mean and frequency of abnormal CRP in first group (n = 27) at 2.1 mg/dL and 48% respectively, were greater than those of the uninfected (n = 296) at 1.2 mg/dL and 27%, respectively. However, there were no differences between two groups regarding mean or frequency of abnormal ESR.
  
  
  CONCLUSIONS
  Some patients with presumed aseptic loosening may have abnormal serologic indicators of PJI that either have escaped diagnosis or were not adequately investigated. All patients undergoing revision THA should have ESR and CRP measured preoperatively and those with abnormal CRP should have additional evaluations to rule out or confirm PJI.
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA. parvj@aol.com
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Suh
authors.forename: S Mehdi
authors.initials: SM
authors.lastname: Jafari
authors.forename: Adam
authors.initials: A
authors.lastname: Mullan
authors.forename: James J
authors.initials: JJ
authors.lastname: Purtill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D001431:Bacteriological Techniques; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D016009:Chi-Square Distribution; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein