ArticleInternational orthopaedics2017
C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections.
Article in International orthopaedics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 4 of them syntheses that pooled it.
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Who cites it
82 citing papers in PubMed, 4 syntheses or guidelines pooled it, 159 citations in OpenAlex.
- Machine Learning Based Diagnostic Models for Hip and Knee Prosthetic Joint Infection: A Systematic Review.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2026Pooled it
- Inflammatory blood parameters as prognostic factors for implant-associated infection after primary total hip or knee arthroplasty: a systematic review.BMC musculoskeletal disorders · 2023Pooled it
- Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection.Journal of orthopaedic surgery and research · 2020Pooled it
- Laboratory-based versus qualitative assessment of α-defensin in periprosthetic hip and knee infections: a systematic review and meta-analysis.Archives of orthopaedic and trauma surgery · 2020Pooled it
- A novel host-based strategy for detecting low-grade prosthetic joint infection using immune cell pattern in synovial fluid.Molecular medicine (Cambridge, Mass.) · 2026Article
- Application of autoantibody markers based on phage display immunoprecipitation sequencing technology in the diagnosis of periprosthetic joint infections.Frontiers in cellular and infection microbiology · 2026Article
- The diagnostic role of albumin-based ratio markers for periprosthetic joint infection.Frontiers in cellular and infection microbiology · 2026Article
- Clinical application of synovial fluid albumin-to-globulin ratio as a novel biomarker in diagnosing chronic periprosthetic joint infection.Frontiers in cellular and infection microbiology · 2026Article
- Performance of established test methods for diagnosing chronic periprosthetic joint infections caused by low-virulence pathogens.Bone & joint research · 2025Article
- Beyond Cultures: The Evolving Role of Molecular Diagnostics, Synovial Biomarkers and Artificial Intelligence in the Diagnosis of Prosthetic Joint Infections.Journal of clinical medicine · 2025Review
- Diagnostic accuracy of the alpha-defensin lateral flow test in periprosthetic shoulder infection: a retrospective study.Clinics in shoulder and elbow · 2025Article
- The Ongoing Struggle to Find a Gold Standard for PJI Diagnosis.Reports (MDPI) · 2025Review
- Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool?Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Article
- A One- or Two-Stage Revision of Fungal Prosthetic Joint Infection: A Review of Current Knowledge, Pitfalls and Recommendations.Antibiotics (Basel, Switzerland) · 2025Review
- No Routine Control Measurements of C-Reactive Protein in Uneventful Postoperative Evolution After Debridement for Infected (Diabetic) Foot Surgery.Journal of clinical medicine · 2025Article
- Current Concepts in Shoulder Periprosthetic Joint Infections-Are Shoulders the Same as Hips and Knees?Journal of clinical medicine · 2025Review
- Nomogram to predict periprosthetic joint infection after total hip arthroplasty using laboratory tests.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Article
- The diagnostic accuracy of blood C-reactive protein and erythrocyte sedimentation rate in periprosthetic joint infections - A 10-year analysis of 1510 revision hip and knee arthroplasties from a single orthopaedic center.Journal of orthopaedic surgery and research · 2025Article
- Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection.Open medicine (Warsaw, Poland) · 2025Article
- The Utility of Synovial Fluid Interleukin-10 in Diagnosing Chronic Periprosthetic Joint Infection: A Prospective Cohort Study.Infection and drug resistance · 2025Article
22 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPeriprosthetic tissue cultures, sonication and synovial fluid cultures remain the gold standard for prosthetic joint infection (PJI) diagnosis. However, some 15-20% culture-negative PJI are still reported. Therefore, there is the need for other diagnostic criteria. One point of concern relative to the different definitions of PJI is as to the inclusion of the c-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) as diagnostic criteria for PJI despite them being non-specific inflammatory blood tests. PURPOSE: The purpose of the present study was to determine the relevance of CRP and the ESR in the diagnosis of PJI.
methodsAll PJI with positive cultures over a two-year period in two hospitals were reviewed. The main variables of the present study were the type of prosthesis and the CRP level. More information was recorded in those patients with normal CRP: radiographs, physical examination records and the ESR.
resultsSeventy-three patients were included in study. Pre-operative CRP levels were normal (lower than 0.8 mg/dl) in 23 patients, representing 32% of all PJI with positive cultures. Low virulence micro-organisms, 12 coagulase-negative staphylococci and four P. acnes, grew in most of them. They represented 70% of all PJI with normal CRP levels. In addition, 17 patients (23% of all PJI with positive cultures) had a normal ESR, a normal physical examination (they only presented with pain) and no clear loosening was observed in the radiographs.
conclusionsPer the American Association of Orthopaedic Surgeons (AAOS) guidelines or the Musculoskeletal Infection Society (MSIS), 23% of the patients in the present study with PJI would never have been identified. Blood inflammatory markers such as the CRP level and ESR may not be accurate as diagnostic tools in PJI, particularly to identify low-grade and chronic PJI.
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