gms | German Medical Science

Joint German Congress of Orthopaedics and Trauma Surgery

02. - 06.10.2006, Berlin

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The value of C-reactive protein, Interleukin 6, Procalcitonin and TNF alpha as marker of periprosthetic infection following total joint arthroplasty

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  • F. Böttner - Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum Münster, Münster, Germany
  • M. Erren - Institut für Labordiagnostik, Universitätsklinikum Münster, Münster, Germany
  • W. Winkelmann - Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum Münster, Münster, Germany
  • C. Götze - Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum Münster, Münster, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 47. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 02.-06.10.2006. Düsseldorf, Köln: German Medical Science; 2006. DocW.6.1-222

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgu2006/06dgu0837.shtml

Published: September 28, 2006

© 2006 Böttner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Methods: 78 patients (41 male and 37 female) with a revision total knee or hip replacement were enrolled in this prospective study to evaluate the role of new laboratory markers in the diagnostic of deep implant infection. The average age at the time of surgery was 64 years. Based on intraoperative cultures, 21 patients had an infected total joint replacement and 57 patients had no evidence of infection. C-reactive protein levels, erythrocyte sedimentation rate, interleukin-6, procalcitonin and TNF-alpha were measured in intraoperative blood samples. Diagnostic cut of values were determined by Receiver Operating Characteristic curve analysis.

Results: If patients with rheumatoid arthritis and other concomitant infections are excluded, the C-reactive protein (>3.2md/dl) and interleukin 6 (> 12 pg/ml) have the highest sensitivity (0.95) of all parameters investigated. Although elevated interleukin 6 levels are more common in septic revisions, this parameter is less specific than the C-reactive protein (0.87 versus 0.98). Procalcitonin (>0.3 ng/ml) is very specific (0.98) but has a low sensitivity (0.33). TNF-alpha (>40ng/ml) has no value for the diagnostic of deep infection.

Conclusion: C-reactive protein and interleukin 6 are the best screening tests for deep implant infection. Combining both marker identifies all patients with infection in the current study.