C-Reactive Protein and Fibrinogen Dynamics Are Predictors of Reinfection Risk After Explantation in Two-Stage Periprosthetic Joint Revision.

BACKGROUND

This study aimed to evaluate early postoperative changes in C-reactive protein (CRP) and fibrinogen after explantation in two-stage revision surgeries and their potential to predict early treatment failure.

METHODS

A total of 288 patients who underwent a two-stage exchange of their total hip arthroplasty or total knee arthroplasty from June 2012 to September 2023 were retrospectively identified. A periprosthetic joint infection was diagnosed based on European Bone and Joint Infection Society criteria. Patients were categorized into two groups: those who did not have failure and those who had early failure within the first year. The two equally sized groups of 72 patients were created through propensity score matching. Absolute and relative CRP and fibrinogen levels and their trajectories were compared based on preoperative values and postoperative on days one, three, and five postoperatively. Furthermore, receiver operating characteristic analysis was conducted.

RESULTS

Significant differences in absolute CRP were observed preoperatively (P = 0.03) and on postoperative day one (P = 0.01). Fibrinogen showed significant differences on days one (P = 0.01) and three (P = 0.01). Relative and absolute CRP changes differed significantly on day three, while fibrinogen changes were significant on day five. The area under the curve of relative fibrinogen values demonstrated the highest prognostic value for early failure with an area under the curve of 0.75 (sensitivity = 0.81, specificity = 0.70).

CONCLUSIONS

This study was the first to specifically examine early postoperative changes in CRP and fibrinogen following explantation in two-stage revision arthroplasty, highlighting the superior prognostic value of fibrinogen compared to CRP in terms of early failure. In particular, monitoring early relative fibrinogen changes may help identify patients at risk of early failure and support timely clinical decision-making.