ESR and CRP are indirect measures of inflammation that are used to detect prosthetic joint infections. ESR levels peak around 5 days post-op and return to normal in 3 months for hip replacements and 9 months for knee replacements. CRP peaks around 2 days and returns to normal in 3 weeks for hips and 2 months for knees. Novel markers like IL-6, procalcitonin, and TNF alpha show better sensitivity and specificity than ESR and CRP. Perioperative antibiotics and strict sterile protocols in the operating theatre can reduce infection risks by over 80%. Large multi-institutional studies are still needed to further advance diagnostic approaches and preventive measures for prosthetic joint infections.

1. PRESENTED BY – Dr ANURAG RANA
MODERATOR – Dr DEVENDRA CHOUHAN

15.  ESR and CRP-
- indirect measure of inflammation
- ESR levels usually peak on the 5TH postoperative
day and drop close to preoperative levels by the end
of the 3RD month after THA and the 9TH month
after TKA
- CRP, on the other hand, rises more rapidly, usually
peaking on the 2ND day and return to normal values
occurs approximately by the 3RD week after THA, and it
may take up to 2 months after TKA

16. ESR > 30mm in 1st hour CRP > 10mg/dl
SENSTIVITY SPECIFICIY SENSTIVITY SPECIFICITY
BERBARI et al 75% 70% 88% 74%
GHANEM et al 94.3% 91.1%
PARVIZI et al 87% 94% 80% 93%

22.  NOVEL MAKERS-
IL6 [>12 pg/ml] - sensitivity 95%
specificity 87%
Procalcitonin [>0.3 ng/ml] specificity 98%,
sensivity of 33%
TNF alpha [>40ng/ml] specificity 94%,
senstivity 43%

42.  Life threatening infection requiring urgent source control
 In 0.1% prosthetic joint infections [ Sierra et al. 2003. Above-the-knee amputation
after a total knee replacement: prevalence, etiology, and functional outcome. J. Bone Joint
Surg. Am]
 Post op antimicrobial therapy varies

44.  Peri operative antimicrobial therapy –
- reduce the risk of infection by 81%
- cephalosporin – within 60 min of skin incision
vancomycin - 60-120 mins prior to surgery
- second dose – blood loss >
period >4 hrs

46.  Strict operation theatre protocols-
-sterile precautions
-laminar air flow
-regular cleaning and fumigation of OTs
• Post surgery precautions-
- barrier nursing
- sterile dressings

47.  Arthroplasty is life enhancing procedure for millions across the globe
 Significant advances in defining ideal approach for diagnosis is
required
 Requires large ,high quality ,multi institutional studies and new
advanced diagnostic techniques.
 Advances in preventive measures