title: Efficacy of erythrocyte sedimentation rate and C-reactive protein level in determining periprosthetic hip infections.
abstract: The diagnosis of periprosthetic hip infections is often challenging. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level blood laboratory tests are commonly used to aid in the diagnosis. We studied the sensitivity, specificity, and false-negative rates of ESR and CRP level in a prospective group of patients who underwent revision total hip arthroplasty between 2000 and 2008. Seventy-seven patients with periprosthetic hip infections and ESR and CRP data were identified. Chi-square analysis was performed to determine the significance of false-negatives, compared with sex, body mass index, primary diagnosis, infection type, and immunity status. ESR had 89% sensitivity and 69% specificity. CRP level had 93% sensitivity and 40% specificity. The false-negative rate was 10.8% for ESR and 7% for CRP level. The false-negative rate for ESR and CRP level combined (with either result positive) was 3%. All false-negatives in the combined group were immunocompromised. Chi-square analysis did not find a significant correlation between false-negatives and any other variables. ESR and CRP level are useful in the diagnosis of periprosthetic hip infections. Ordering these tests concurrently reduces the chance of false-negative results.
authors.affiliation: Rubin Institute for Advanced Orthopaedics, Sinai Hospital, Baltimore, Maryland, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Costa
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Johnson
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.forename: German A
authors.initials: GA
authors.lastname: Maralunda
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D002908:Chronic Disease; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis*; D012086:Reoperation; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein