{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:57:59Z","timestamp":1790279879628,"version":"4.1.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Although two-stage revision surgery is considered as the most effective treatment for managing chronic periprosthetic joint infection (PJI), there is no current consensus on the predictors of optimal timing to second-stage reimplantation. This study aimed to compare clinical outcomes between patients with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) prior to second-stage reimplantation and those with normalized ESR and CRP prior to second-stage reimplantation. We retrospectively reviewed 198 patients treated with two-stage revision total knee arthroplasty for chronic PJI. Cohorts included patients with: (1) normal level of serum ESR and CRP (n\u2009=\u200996) and (2) elevated level of serum ESR and CRP prior to second-stage reimplantation (n\u2009=\u2009102). Outcomes including reinfection rates and readmission rates were compared between both cohorts. At a mean follow-up of 4.4 years (2.8\u20136.5 years), the elevated ESR and CRP cohort demonstrated significantly higher reinfection rates compared with patients with normalized ESR and CRP prior to second-stage reimplantation (33.3% vs. 14.5%, p\u2009&lt;\u20090.01). Patients with both elevated ESR and CRP demonstrated significantly higher reinfection rates, when compared with patients with elevated ESR and normalized CRP (33.3% vs. 27.6%, p\u2009=\u20090.02) as well as normalized ESR and elevated CRP (33.3% vs. 26.3%, p\u2009&lt;\u20090.01). This study demonstrates that elevated serum ESR and\/or CRP levels prior to reimplantation in two-stage knee revision surgery for chronic PJI are associated with increased reinfection rate after surgery. Elevation of both ESR and CRP were associated with a higher risk of reinfection compared with elevation of either ESR or CRP, suggesting the potential benefits of normalizing ESR and CRP prior to reimplantation in treatment of chronic PJI.<\/jats:p>","DOI":"10.1055\/s-0041-1733902","type":"journal-article","created":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T22:53:53Z","timestamp":1628636033000},"page":"354-361","source":"Crossref","is-referenced-by-count":16,"title":["Elevated ESR and CRP Prior to Second-Stage Reimplantation Knee Revision Surgery for Periprosthetic Joint Infection Are Associated with Increased Reinfection Rates"],"prefix":"10.1055","volume":"36","author":[{"given":"Christian","family":"Klemt","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Padmanabha","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Laurencin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Min","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,8,10]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1016\/j.arth.2019.06.021","article-title":"Two-stage exchange arthroplasty for periprosthetic joint infection: the rate and reason for the attrition after the first stage","volume":"34","author":"Q Wang","year":"2019","journal-title":"J Arthroplasty"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.1007\/s00167-012-1885-x","article-title":"Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers","volume":"20","author":"C L Roman\u00f2","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11999-015-4408-5","article-title":"Can good infection control be obtained in one-stage exchange of the infected TKA to a rotating hinge design? 10-year results","volume":"474","author":"A Zahar","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1007\/s11999-011-2174-6","article-title":"High rate of infection control with one-stage revision of septic knee prostheses excluding MRSA and MRSE","volume":"470","author":"J Singer","year":"2012","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s11999-014-3721-8","article-title":"Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections?","volume":"473","author":"F S Haddad","year":"2015","journal-title":"Clin Orthop Relat Res"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.07.012","article-title":"Single-stage revision of the infected total knee arthroplasty is associated with improved functional outcomes: a propensity score matched cohort study","author":"C Klemt","year":"2020","journal-title":"J Arthroplasty"},{"issue":"18","key":"ref7","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.2106\/JBJS.N.00958","article-title":"The fate of spacers in the treatment of periprosthetic joint infection","volume":"97","author":"M M Gomez","year":"2015","journal-title":"J Bone Joint Surg Am"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.09.012","article-title":"Outcomes and risk factors associated with 2-stage reimplantation requiring an interim spacer exchange for periprosthetic joint infection","author":"C Klemt","year":"2020","journal-title":"J Arthroplasty"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.2106\/00004623-200011000-00006","article-title":"Evaluation of preoperative cultures before second-stage reimplantation of a total knee prosthesis complicated by infection. A comparison-group study","volume":"82","author":"M A Mont","year":"2000","journal-title":"J Bone Joint Surg Am"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2174\/1874325001004010193","article-title":"Two stage hip revision in periprosthetic infection: results of 41 cases","volume":"4","author":"G Pignatti","year":"2010","journal-title":"Open Orthop J"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"635","DOI":"10.2106\/JBJS.18.00632","article-title":"Diagnostic accuracy of serum, synovial, and tissue testing for chronic periprosthetic joint infection after hip and knee replacements: a systematic review","volume":"101","author":"A V Carli","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"42","DOI":"10.2106\/JBJS.16.01522","article-title":"The accuracy of the alpha defensin lateral flow device for diagnosis of periprosthetic joint infection: comparison with a gold standard","volume":"100","author":"T Gehrke","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"167","DOI":"10.7150\/jbji.34854","article-title":"Factors to consider when assessing the diagnostic accuracy of synovial leukocyte count in periprosthetic joint infection","volume":"4","author":"K D Ottink","year":"2019","journal-title":"J Bone Jt Infect"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1007\/s11999-016-5093-8","article-title":"What is the diagnostic accuracy of aspirations performed on hips with antibiotic cement spacers?","volume":"475","author":"J M Newman","year":"2017","journal-title":"Clin Orthop Relat Res"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1302\/0301-620X.100B6.BJJ-2017-0970.R2","article-title":"Joint aspiration, including culture of reaspirated saline after a \u2018dry tap\u2019, is sensitive and specific for the diagnosis of hip and knee prosthetic joint infection","volume":"100-B","author":"D G Partridge","year":"2018","journal-title":"Bone Joint J"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2106\/JBJS.17.00874","article-title":"Reconsidering strategies for managing chronic periprosthetic joint infection in total knee arthroplasty: using decision analytics to find the optimal strategy between one-stage and two-stage total knee revision","volume":"101","author":"K Srivastava","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1302\/0301-620X.78B5.0780838","article-title":"Gram stain detection of infection during revision arthroplasty","volume":"78","author":"G F Chimento","year":"1996","journal-title":"J Bone Joint Surg Br"},{"issue":"04","key":"ref18","first-page":"869","article-title":"Diagnosis of periprosthetic infection","volume":"88","author":"T W Bauer","year":"2006","journal-title":"J Bone Joint Surg Am"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.1007\/s11999-013-2866-1","article-title":"Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus","volume":"471","author":"C Diaz-Ledezma","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"464","key":"ref20","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/BLO.0b013e318157eb1e","article-title":"Technique and timing of two-stage exchange for infection in TKA","volume":"464","author":"R SJ Burnett","year":"2007","journal-title":"Clin Orthop Relat Res"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.arth.2006.01.028","article-title":"The results of articulating spacer technique for infected total knee arthroplasty","volume":"21","author":"H-T Huang","year":"2006","journal-title":"J Arthroplasty"},{"key":"ref22","first-page":"345475","article-title":"Two-stage revision arthroplasty for periprosthetic hip infection: mean follow-up of ten years","volume":"2015","author":"S-Y Chen","year":"2015","journal-title":"BioMed Res Int"},{"issue":"403","key":"ref23","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00003086-200210000-00003","article-title":"Periprosthetic total hip infection: outcomes using a staging system","author":"E J McPherson","year":"2002","journal-title":"Clin Orthop Relat Res"},{"issue":"11","key":"ref24","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"J Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1007\/s11999-010-1619-7","article-title":"What is the role of serological testing between stages of two-stage reconstruction of the infected prosthetic knee?","volume":"469","author":"S K Kusuma","year":"2011","journal-title":"Clin Orthop Relat Res"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.arth.2010.05.006","article-title":"Perioperative testing for persistent sepsis following resection arthroplasty of the hip for periprosthetic infection","volume":"25","author":"S K Shukla","year":"2010","journal-title":"J Arthroplasty"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/01.blo.0000533618.31937.45","article-title":"Does change in ESR and CRP guide the timing of two-stage arthroplasty reimplantation?","volume":"477","author":"J B Stambough","year":"2019","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.artd.2016.08.002","article-title":"ESR and CRP are useful between stages of 2-stage revision for periprosthetic joint infection","volume":"3","author":"C P Lindsay","year":"2017","journal-title":"Arthroplast Today"},{"issue":"07","key":"ref29","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s11999-009-0742-9","article-title":"Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation?","volume":"467","author":"E Ghanem","year":"2009","journal-title":"Clin Orthop Relat Res"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"115088","DOI":"10.1016\/j.poly.2021.115088","article-title":"A new 1\u20131-4 pattern of magnetic exchange interactions in a cubane core tetranuclear copper (II) complex","volume":"199","author":"A Mehrani","year":"2021","journal-title":"Polyhedron"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1038\/s41467-021-22012-7","article-title":"trans-Translation inhibitors bind to a novel site on the ribosome and clear Neisseria gonorrhoeae in vivo","volume":"12","author":"Z D Aron","year":"2021","journal-title":"Nat Commun"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.08.004","article-title":"Development of a preoperative risk calculator for re-infection following revision surgery for periprosthetic joint infection","author":"C Klemt","year":"2020","journal-title":"J Arthroplasty"},{"issue":"06","key":"ref33","first-page":"317","article-title":"Erythrocyte sedimentation rate and C-reactive protein measurements and their relevance in clinical medicine","volume":"115","author":"C Bray","year":"2016","journal-title":"WMJ"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.2147\/TCRM.S175854","article-title":"Preoperatively elevated serum inflammatory markers increase the risk of periprosthetic joint infection following total knee arthroplasty in patients with osteoarthritis","volume":"14","author":"C Xu","year":"2018","journal-title":"Ther Clin Risk Manag"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1186\/s13018-019-1389-1","article-title":"Factors associated with the length of stay in total knee arthroplasty patients with the enhanced recovery after surgery model","volume":"14","author":"G Li","year":"2019","journal-title":"J Orthop Surg Res"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/s10904-015-0302-6","article-title":"Double functionalized nanoporous magnetic gadolinium\u2013silica composite for doxorubicin delivery","volume":"26","author":"A Mehrani","year":"2016","journal-title":"J Inorg Organomet Polym Mater"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1733902.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,26]],"date-time":"2023-02-26T23:58:38Z","timestamp":1677455918000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1733902"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,10]]},"references-count":36,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,2,26]]},"published-print":{"date-parts":[[2023,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1733902","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,10]]}}}