{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:03:21Z","timestamp":1760148201491,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>In elderly patients with femoral neck fractures, preoperative serum C-reactive protein (CRP) values might be elevated due to active infections. Although there are limited data on CRP as a predictor of periprosthetic joint infection (PJI), out of concern, this could lead to delayed surgery. Therefore, we aim to investigate whether elevated serum-CRP levels justify delayed surgery for femoral neck fractures. A retrospective analysis was performed of the records of patients undergoing arthroplasty who were found to have an elevated CRP level of 5 mg\/dL or more between January 2011 to December 2020. The patients were stratified to three groups, according to initial serum CRP levels at a cut off of 5 mg\/dL and the time between admission and surgery (&lt;48 vs. \u226548 h after admission). This study revealed that the patients with elevated serum CRP levels and delayed surgery showed a worse survival rate and significantly more postoperative complications than the patients on whom surgery was performed immediately. There were no significant differences in terms of PJI and prolonged wound healing in the inter-group comparison. Therefore, delays to surgery on the basis of elevated CRP values offer no benefits to patients with femoral neck fractures.<\/jats:p>","DOI":"10.3390\/antibiotics12040738","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T03:11:23Z","timestamp":1681182683000},"page":"738","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Do Elevated Serum C-Reactive-Protein Levels Excuse Delayed Surgery for Femoral Neck Fractures?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7822-7529","authenticated-orcid":false,"given":"Roberta","family":"Laggner","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6433-5022","authenticated-orcid":false,"given":"Benan","family":"Taner","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2576-1717","authenticated-orcid":false,"given":"Jennifer","family":"Straub","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8698-8341","authenticated-orcid":false,"given":"Thomas Manfred","family":"Tiefenb\u00f6ck","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harlad","family":"Binder","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Sator","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Hajdu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6321-1804","authenticated-orcid":false,"given":"Reinhard","family":"Windhager","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"B\u00f6hler","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/j.injury.2017.03.007","article-title":"Neck of femur fractures in the elderly: Does every hour to surgery count?","volume":"48","author":"Morrissey","year":"2017","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1302\/0301-620X.97B3.35738","article-title":"Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation\u2014A prospective cohort study","volume":"97-B","author":"Griffin","year":"2015","journal-title":"Bone Jt. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S95","DOI":"10.1016\/j.otsr.2018.04.034","article-title":"Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures?","volume":"105","author":"Guyen","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1302\/0301-620X.102B6.BJJ-2019-1459.R1","article-title":"Treatment of displaced intracapsular fractures of the femoral neck with total hip arthroplasty or hemiarthroplasty","volume":"102-B","author":"Viswanath","year":"2020","journal-title":"Bone Jt. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1302\/0301-620X.99B8.BJJ-2016-1119.R1","article-title":"Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur","volume":"99-B","author":"Klem","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1302\/0301-620X.87B6.15121","article-title":"Infection of the surgical site after arthroplasty of the hip","volume":"87","author":"Ridgeway","year":"2005","journal-title":"J. Bone Jt. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1302\/0301-620X.105B2.BJJ-2022-1035.R1","article-title":"Periprosthetic hip infection in octogenarians: A single institution experience of 33 cases","volume":"105-B","author":"Karczewski","year":"2023","journal-title":"Bone Jt. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.archger.2009.06.006","article-title":"Older age and type of surgery predict the early inflammatory response to hip trauma mediated by interleukin-6 (IL-6)","volume":"51","author":"Sedlar","year":"2010","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_9","first-page":"e22270","article-title":"C-reactive Protein Is a Diagnostic Tool for Postoperative Infection in Orthopaedics","volume":"14","author":"Shetty","year":"2022","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"C19","DOI":"10.1016\/j.jacc.2005.10.066","article-title":"C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients","volume":"47","author":"Tsimikas","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1007\/s00132-008-1342-1","article-title":"C-reactive protein. An independent risk factor for the development of infection after primary arthroplasty","volume":"37","author":"Pfitzner","year":"2008","journal-title":"Orthopade"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s00590-014-1449-5","article-title":"Can preoperative CRP levels predict infections of bipolar hemiarthroplasty performed for femoral neck fracture? A retrospective, multicenter study","volume":"25","author":"Buchheit","year":"2015","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00068-018-0909-8","article-title":"Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture","volume":"45","author":"Zajonz","year":"2019","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","article-title":"The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria","volume":"33","author":"Parvizi","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S108","DOI":"10.1002\/jor.22554","article-title":"Wound management","volume":"32","author":"Ghanem","year":"2014","journal-title":"J. Orthop. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"547","DOI":"10.6061\/clinics\/2012(06)02","article-title":"Early interdisciplinary hospital intervention for elderly patients with hip fractures: Functional outcome and mortality","volume":"67","year":"2012","journal-title":"Clinics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/S0140-6736(98)09075-8","article-title":"Mortality after all major types of osteoporotic fracture in men and women: An observational study","volume":"353","author":"Center","year":"1999","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1136\/bmj.38643.663843.55","article-title":"Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study","volume":"331","author":"Roche","year":"2005","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/s00198-006-0173-3","article-title":"Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: A probabilistic record linkage study in Brazil","volume":"17","author":"Vidal","year":"2006","journal-title":"Osteoporos. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jhin.2006.01.015","article-title":"Deep wound infection after proximal femoral fracture: Consequences and costs","volume":"63","author":"Pollard","year":"2006","journal-title":"J. Hosp. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1302\/0301-620X.90B6.20194","article-title":"Early infection after hip fracture surgery: Risk factors, costs and outcome","volume":"90","author":"Edwards","year":"2008","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.injury.2006.08.028","article-title":"Impact of surgical complications on length of stay after hip fracture surgery","volume":"38","author":"Foss","year":"2007","journal-title":"Injury"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.2106\/JBJS.17.01485","article-title":"Extended Oral Antibiotic Prophylaxis in High-Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate","volume":"100","author":"Inabathula","year":"2018","journal-title":"J. Bone Jt. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1056\/NEJMoa0707402","article-title":"Genetically elevated C-reactive protein and ischemic vascular disease","volume":"359","author":"Zacho","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"676105","DOI":"10.3389\/fimmu.2021.676105","article-title":"Relationship Between Inflammation and Metabolism in Patients With Newly Presenting Rheumatoid Arthritis","volume":"12","author":"Jutley","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1053\/sarh.2000.8366","article-title":"Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: A prospective follow-up study","volume":"30","author":"Cantini","year":"2000","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"166.e17","DOI":"10.1016\/j.amjmed.2005.06.057","article-title":"What does minor elevation of C-reactive protein signify?","volume":"119","author":"Kushner","year":"2006","journal-title":"Am. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mederake, M., Hofmann, U.K., Benda, S., Schuster, P., and Fink, B. (2022). Diagnostic Value of CRP and Serum WBC Count during Septic Two-Stage Revision of Total Hip Arthroplasties. Antibiotics, 11.","DOI":"10.3390\/antibiotics11081098"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Khury, F., Oltmanns, M., Fuchs, M., Leiprecht, J., Reichel, H., and Faschingbauer, M. (2022). Against the Norm: Do Not Rely on Serum C-Reactive Protein and White Blood Cell Count Only When Assessing Eradication of Periprosthetic Joint Infection. Antibiotics, 11.","DOI":"10.3390\/antibiotics11091174"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s10195-020-0542-2","article-title":"C-reactive protein is not a screening tool for late periprosthetic joint infection","volume":"21","author":"Fink","year":"2020","journal-title":"J. Orthop. Traumatol."},{"key":"ref_31","first-page":"e316","article-title":"Causes and outcomes of markedly elevated C-reactive protein levels","volume":"63","author":"Landry","year":"2017","journal-title":"Can. Fam. Physician"},{"key":"ref_32","first-page":"2351","article-title":"The influence of age, sex, and race on the upper reference limit of serum C-reactive protein concentration","volume":"27","author":"Wener","year":"2000","journal-title":"J. Rheumatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4055\/cios21110","article-title":"Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty","volume":"14","author":"Rohe","year":"2022","journal-title":"Clin. Orthop. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2174\/157339910790442628","article-title":"The connection between C-reactive protein (CRP) and diabetic vasculopathy. Focus on preclinical findings","volume":"6","author":"Mugabo","year":"2010","journal-title":"Curr. Diabetes Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00402-019-03304-6","article-title":"Risk factors for periprosthetic joint infection after total knee arthroplasty","volume":"140","author":"Blanco","year":"2020","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1017\/ice.2015.249","article-title":"Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis","volume":"37","author":"Martin","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.arth.2018.08.034","article-title":"Persistent Wound Drainage After Total Joint Arthroplasty: A Narrative Review","volume":"34","author":"Wagenaar","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.artd.2019.05.003","article-title":"The risk factors and an evidence-based protocol for the management of persistent wound drainage after total hip and knee arthroplasty","volume":"5","author":"Shahi","year":"2019","journal-title":"Arthroplast. Today"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.arth.2004.03.025","article-title":"Hemiarthroplasty for femoral neck fracture in the elderly surgeon and hospital volume-related outcomes","volume":"20","author":"Shah","year":"2005","journal-title":"J. Arthroplast."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/BF00192477","article-title":"The value of a special surgical team in preventing complications in the treatment of hip fractures","volume":"18","author":"Parker","year":"1994","journal-title":"Int. Orthop."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/4\/738\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:13:42Z","timestamp":1760123622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/4\/738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,11]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["antibiotics12040738"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12040738","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2023,4,11]]}}}