{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:57:17Z","timestamp":1784127437514,"version":"3.55.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T00:00:00Z","timestamp":1660003200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T00:00:00Z","timestamp":1660003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007653","name":"Universit\u00e4tsklinikum Jena","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007653","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) remains a serious complication in orthopaedic surgery. C-reactive protein (CRP) is widely used as a marker to screen for inflammatory complications. The early postoperative course is well known, but knowledge about the predictive value of CRP in the first 6 postoperative days for detecting an acute postoperative PJI is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed the inpatient course of CRP of all primary THA and THA with acute PJI within 28\u00a0days in our hospital from 2013 to 2021. A receiver-operating curve (ROC) analysis was performed and the best CRP threshold for detecting an acute PJI based on Youden\u2019s-index was calculated and an area-under-the curve (AUC) analysis of the threshold was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>33 of 7042 patients included had an acute PJI within 28\u00a0days. Patients with acute PJI were older, had a higher BMI and longer operation time and suffered more often from diabetes mellitus. A preoperatively elevated CRP was a risk factor for PJI. CRP was significantly higher in the PJI group on postoperative days 3 and 5. Threshold values were calculated to be 152\u00a0mg\/l on day 3 and 73\u00a0mg\/l on day 5. However, these values had a low sensitivity (75%, 76%) and specificity (67%, 61%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Especially considering the decreasing length of stay after THA, the question of the usefulness of regular inpatient CRP checks arises. AUC analysis of the ROC showed a poor diagnostic accuracy in almost all cases. Only the dynamic analysis of the maximum CRP value to the lowest CRP value with a decrease of 102.7\u00a0mg\/l showed a fair accuracy. This calls into question the clinical relevance of CRP in the first postoperative week for detection of acute postoperative PJI.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00402-022-04565-4","type":"journal-article","created":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T08:02:38Z","timestamp":1660032158000},"page":"3495-3503","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["C-reactive protein during the first 6 postoperative days after total hip arthroplasty cannot predict early periprosthetic infection"],"prefix":"10.1007","volume":"143","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0015-9209","authenticated-orcid":false,"given":"Sebastian","family":"Rohe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"B\u00f6hle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Matziolis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgi","family":"Wassilew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Brodt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,8,9]]},"reference":[{"key":"4565_CR1","first-page":"151","volume":"23","author":"O Moreschini","year":"2001","unstructured":"Moreschini O, Greggi G, Giordano MC et al (2001) Postoperative physiopathological analysis of inflammatory parameters in patients undergoing hip or knee arthroplasty. Int J Tissue React 23:151\u2013154","journal-title":"Int J Tissue React"},{"key":"4565_CR2","doi-asserted-by":"crossref","first-page":"327","DOI":"10.55095\/achot2015\/054","volume":"82","author":"M Neumaier","year":"2015","unstructured":"Neumaier M, Braun KF, Sandmann G et al (2015) C-reactive protein in orthopaedic surgery. Acta Chir Orthop Traumatol Cech 82:327\u2013331","journal-title":"Acta Chir Orthop Traumatol Cech"},{"key":"4565_CR3","doi-asserted-by":"publisher","first-page":"330","DOI":"10.3109\/17453670903066596","volume":"80","author":"H Shen","year":"2009","unstructured":"Shen H, Zhang N, Zhang X et al (2009) C-reactive protein levels after 4 types of arthroplasty. Acta Orthop 80:330\u2013333. https:\/\/doi.org\/10.3109\/17453670903066596","journal-title":"Acta Orthop"},{"key":"4565_CR4","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1515\/cclm-2014-1055","volume":"53","author":"MK Wasko","year":"2015","unstructured":"Wasko MK, Bobecka-Weso\u0142owska K, Tomasiuk R et al (2015) Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty. Clin Chem Lab Med 53:1785\u20131792. https:\/\/doi.org\/10.1515\/cclm-2014-1055","journal-title":"Clin Chem Lab Med"},{"key":"4565_CR5","doi-asserted-by":"crossref","unstructured":"Larsson S, Thelander U, Friberg S (1992) C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res:237\u2013242","DOI":"10.1097\/00003086-199202000-00035"},{"key":"4565_CR6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1177\/147323000102900102","volume":"29","author":"O Bilgen","year":"2001","unstructured":"Bilgen O, Atici T, Durak K et al (2001) C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res 29:7\u201312. https:\/\/doi.org\/10.1177\/147323000102900102","journal-title":"J Int Med Res"},{"key":"4565_CR7","doi-asserted-by":"publisher","DOI":"10.4055\/cios21110","author":"S Rohe","year":"2022","unstructured":"Rohe S, R\u00f6hner E, Windisch C et al (2022) Sex differences in serum C-reactive protein course after total hip arthroplasty. Clin Orthop Surg. https:\/\/doi.org\/10.4055\/cios21110","journal-title":"Clin Orthop Surg"},{"key":"4565_CR8","doi-asserted-by":"publisher","first-page":"C19","DOI":"10.1016\/j.jacc.2005.10.066","volume":"47","author":"S Tsimikas","year":"2006","unstructured":"Tsimikas S, Willerson JT, Ridker PM (2006) C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J Am Coll Cardiol 47:C19-31. https:\/\/doi.org\/10.1016\/j.jacc.2005.10.066","journal-title":"J Am Coll Cardiol"},{"key":"4565_CR9","doi-asserted-by":"publisher","first-page":"274","DOI":"10.3109\/07853890009011772","volume":"32","author":"TW Du Clos","year":"2000","unstructured":"Du Clos TW (2000) Function of C-reactive protein. Ann Med 32:274\u2013278. https:\/\/doi.org\/10.3109\/07853890009011772","journal-title":"Ann Med"},{"key":"4565_CR10","doi-asserted-by":"publisher","first-page":"48487","DOI":"10.1074\/jbc.R400025200","volume":"279","author":"S Black","year":"2004","unstructured":"Black S, Kushner I, Samols D (2004) C-reactive protein. J Biol Chem 279:48487\u201348490. https:\/\/doi.org\/10.1074\/jbc.R400025200","journal-title":"J Biol Chem"},{"key":"4565_CR11","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1302\/0301-620X.78B3.0780431","volume":"78","author":"RO Niskanen","year":"1996","unstructured":"Niskanen RO, Korkala O, Pammo H (1996) Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg Br 78:431\u2013433","journal-title":"J Bone Joint Surg Br"},{"key":"4565_CR12","doi-asserted-by":"publisher","first-page":"S325","DOI":"10.1016\/j.arth.2018.09.045","volume":"34","author":"N Shohat","year":"2019","unstructured":"Shohat N, Bauer T, Buttaro M et al (2019) Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? proceedings of can the same criteria be used for both joints? international consensus on orthopedic infections. J Arthroplasty 34:S325\u2013S327. https:\/\/doi.org\/10.1016\/j.arth.2018.09.045","journal-title":"J Arthroplasty"},{"key":"4565_CR13","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","volume":"33","author":"J Parvizi","year":"2018","unstructured":"Parvizi J, Tan TL, Goswami K et al (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33:1309-1314.e2. https:\/\/doi.org\/10.1016\/j.arth.2018.02.078","journal-title":"J Arthroplasty"},{"key":"4565_CR14","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1007\/s11999-013-3089-1","volume":"472","author":"PH Yi","year":"2014","unstructured":"Yi PH, Cross MB, Moric M et al (2014) The 2013 Frank Stinchfield Award: diagnosis of infection in the early postoperative period after total hip arthroplasty. Clin Orthop Relat Res 472:424\u2013429. https:\/\/doi.org\/10.1007\/s11999-013-3089-1","journal-title":"Clin Orthop Relat Res"},{"key":"4565_CR15","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.2106\/JBJS.20.00257","volume":"102","author":"K Sukhonthamarn","year":"2020","unstructured":"Sukhonthamarn K, Tan TL, Xu C et al (2020) Determining diagnostic thresholds for acute postoperative periprosthetic joint infection. J Bone Joint Surg Am 102:2043\u20132048. https:\/\/doi.org\/10.2106\/JBJS.20.00257","journal-title":"J Bone Joint Surg Am"},{"key":"4565_CR16","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.clinbiochem.2015.10.018","volume":"49","author":"G Chapman","year":"2016","unstructured":"Chapman G, Holton J, Chapman A (2016) A threshold for concern? C-reactive protein levels following operatively managed neck of femur fractures can detect infectious complications with a simple formula. Clin Biochem 49:219\u2013224. https:\/\/doi.org\/10.1016\/j.clinbiochem.2015.10.018","journal-title":"Clin Biochem"},{"key":"4565_CR17","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/s00402-018-3058-y","volume":"139","author":"A Pellegrini","year":"2019","unstructured":"Pellegrini A, Legnani C, Meani E (2019) A new perspective on current prosthetic joint infection classifications: introducing topography as a key factor affecting treatment strategy. Arch Orthop Trauma Surg 139:317\u2013322. https:\/\/doi.org\/10.1007\/s00402-018-3058-y","journal-title":"Arch Orthop Trauma Surg"},{"key":"4565_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ocl.2018.08.001","volume":"50","author":"AM Elbuluk","year":"2019","unstructured":"Elbuluk AM, Novikov D, Gotlin M et al (2019) Control strategies for infection prevention in total joint arthroplasty. Orthop Clin North Am 50:1\u201311. https:\/\/doi.org\/10.1016\/j.ocl.2018.08.001","journal-title":"Orthop Clin North Am"},{"key":"4565_CR19","doi-asserted-by":"publisher","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","volume":"469","author":"J Parvizi","year":"2011","unstructured":"Parvizi J, Zmistowski B, Berbari EF et al (2011) New definition for periprosthetic joint infection: from the Workgroup of the musculoskeletal infection society. Clin Orthop Relat Res 469:2992\u20132994. https:\/\/doi.org\/10.1007\/s11999-011-2102-9","journal-title":"Clin Orthop Relat Res"},{"key":"4565_CR20","doi-asserted-by":"publisher","first-page":"512","DOI":"10.2106\/00004623-199604000-00005","volume":"78","author":"DT Tsukayama","year":"1996","unstructured":"Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. a study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78:512\u2013523. https:\/\/doi.org\/10.2106\/00004623-199604000-00005","journal-title":"J Bone Joint Surg Am"},{"key":"4565_CR21","doi-asserted-by":"publisher","first-page":"c179","DOI":"10.1159\/000339789","volume":"120","author":"A Khwaja","year":"2012","unstructured":"Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179\u2013c184. https:\/\/doi.org\/10.1159\/000339789","journal-title":"Nephron Clin Pract"},{"key":"4565_CR22","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1055\/s-0034-1366278","volume":"122","author":"W Kerner","year":"2014","unstructured":"Kerner W, Br\u00fcckel J (2014) Definition, classification and diagnosis of diabetes mellitus. Exp Clin Endocrinol Diabetes 122:384\u2013386. https:\/\/doi.org\/10.1055\/s-0034-1366278","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"4565_CR23","volume-title":"Obesity: Preventing and managing the global epidemic; report of a WHO Consultation; [1999, Geneva] WHO technical report series","author":"WH Organization","year":"2000","unstructured":"Organization WH (2000) Obesity: Preventing and managing the global epidemic; report of a WHO Consultation; [1999, Geneva] WHO technical report series. World Health Organization, Geneva"},{"key":"4565_CR24","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32:AID-CNCR2820030106>3.0.CO;2-3","volume":"3","author":"WJ Youden","year":"1950","unstructured":"Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32\u201335. https:\/\/doi.org\/10.1002\/1097-0142(1950)3:1%3c32:AID-CNCR2820030106%3e3.0.CO;2-3","journal-title":"Cancer"},{"key":"4565_CR25","doi-asserted-by":"publisher","first-page":"207","DOI":"10.11919\/j.issn.1002-0829.218052","volume":"30","author":"F Li","year":"2018","unstructured":"Li F, He H (2018) Assessing the Accuracy of Diagnostic Tests. Shanghai Arch Psychiatr 30:207\u2013212. https:\/\/doi.org\/10.11919\/j.issn.1002-0829.218052","journal-title":"Shanghai Arch Psychiatr"},{"key":"4565_CR26","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.otsr.2015.12.017","volume":"102","author":"J-Y Jenny","year":"2016","unstructured":"Jenny J-Y, Adamczewski B, de Thomasson E et al (2016) Can the presence of an infection be predicted before a revision total hip arthroplasty? preliminary study to establish an infection score. Orthop Traumatol Surg Res 102:161\u2013165. https:\/\/doi.org\/10.1016\/j.otsr.2015.12.017","journal-title":"Orthop Traumatol Surg Res"},{"key":"4565_CR27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0131609","volume":"10","author":"CA Petti","year":"2015","unstructured":"Petti CA, Stoddard GJ, Sande MA et al (2015) The suspected infected prosthetic joint: clinical acumen and added value of laboratory investigations. PLoS ONE 10:e0131609. https:\/\/doi.org\/10.1371\/journal.pone.0131609","journal-title":"PLoS ONE"},{"key":"4565_CR28","doi-asserted-by":"publisher","first-page":"2744","DOI":"10.1016\/j.arth.2019.06.048","volume":"34","author":"C Xu","year":"2019","unstructured":"Xu C, Tan TL, Kuo F-C et al (2019) Reevaluating current cutoffs for acute periprosthetic joint infection: current thresholds are insensitive. J Arthroplast 34:2744\u20132748. https:\/\/doi.org\/10.1016\/j.arth.2019.06.048","journal-title":"J Arthroplast"},{"key":"4565_CR29","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1007\/s00132-008-1342-1","volume":"37","author":"T Pfitzner","year":"2008","unstructured":"Pfitzner T, Krocker D, Perka C et al (2008) Das C-reaktive Protein. Ein unabh\u00e4ngiger Risikofaktor f\u00fcr die Entwicklung eines Infekts nach Prim\u00e4rendoprothetik (C-reactive protein. an independent risk factor for the development of infection after primary arthroplasty). Orthopade 37:1116\u20131120. https:\/\/doi.org\/10.1007\/s00132-008-1342-1","journal-title":"Orthopade"},{"key":"4565_CR30","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/s1010-7940(98)00062-1","volume":"13","author":"U Boeken","year":"1998","unstructured":"Boeken U (1998) Increased preoperative C-reactive protein (CRP)-values without signs of an infection and complicated course after cardiopulmonary bypass (CPB) \u2013 operations. Eur J Cardiothorac Surg 13:541\u2013545. https:\/\/doi.org\/10.1016\/s1010-7940(98)00062-1","journal-title":"Eur J Cardiothorac Surg"},{"key":"4565_CR31","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/s00068-018-0909-8","volume":"45","author":"D Zajonz","year":"2019","unstructured":"Zajonz D, Brand A, Lycke C et al (2019) Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture. Eur J Trauma Emerg Surg 45:207\u2013212. https:\/\/doi.org\/10.1007\/s00068-018-0909-8","journal-title":"Eur J Trauma Emerg Surg"},{"key":"4565_CR32","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/j.amjsurg.2017.08.021","volume":"215","author":"E Mujagic","year":"2018","unstructured":"Mujagic E, Marti WR, Coslovsky M et al (2018) The role of preoperative blood parameters to predict the risk of surgical site infection. Am J Surg 215:651\u2013657. https:\/\/doi.org\/10.1016\/j.amjsurg.2017.08.021","journal-title":"Am J Surg"},{"key":"4565_CR33","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/iwj.12640","volume":"14","author":"L Kong","year":"2017","unstructured":"Kong L, Cao J, Zhang Y et al (2017) Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 14:529\u2013536. https:\/\/doi.org\/10.1111\/iwj.12640","journal-title":"Int Wound J"},{"key":"4565_CR34","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1007\/s00167-018-5231-9","volume":"29","author":"VAC Resende","year":"2021","unstructured":"Resende VAC, Neto AC, Nunes C et al (2021) Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 29:8\u201343. https:\/\/doi.org\/10.1007\/s00167-018-5231-9","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4565_CR35","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-021-00442-x","author":"SK Kunutsor","year":"2021","unstructured":"Kunutsor SK, Whitehouse MR, Blom AW (2021) Obesity paradox in joint replacement for osteoarthritis - truth or paradox? Geroscience. https:\/\/doi.org\/10.1007\/s11357-021-00442-x","journal-title":"Geroscience"},{"key":"4565_CR36","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.arth.2015.09.003","volume":"31","author":"PK Cavanaugh","year":"2016","unstructured":"Cavanaugh PK, Chen AF, Rasouli MR et al (2016) Complications and mortality in chronic renal failure patients undergoing total joint arthroplasty: a comparison between dialysis and renal transplant patients. J Arthroplasty 31:465\u2013472. https:\/\/doi.org\/10.1016\/j.arth.2015.09.003","journal-title":"J Arthroplasty"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04565-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-022-04565-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04565-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,25]],"date-time":"2023-11-25T12:14:36Z","timestamp":1700914476000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-022-04565-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,9]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["4565"],"URL":"https:\/\/doi.org\/10.1007\/s00402-022-04565-4","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,9]]},"assertion":[{"value":"15 April 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"Ethical approval was done by the local Ethics Committee of University Jena in view of the retrospective nature of the study. All procedures being performed were part of routine care (RNr. 2021\u20132310-Daten). Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}