Factors Associated With Elevated Inflammatory Markers Prior to Shoulder Arthroplasty

Abstract

Background: Preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) ranges for several shoulder arthroplasty indications are not well understood. Purpose: We sought to compare preoperative ESR and CRP values for a variety of shoulder arthroplasty indications and evaluate risk factors for elevated preoperative ESR and CRP values. Methods: We conducted a retrospective cohort study of shoulder arthroplasty cases performed at a single academic medical institution from 2013 to 2018. Preoperative ESR and CRP values for 235 shoulder arthroplasties with various indications were recorded. Independent risk factors for elevated values (CRP > 10.0 mg/L and ESR > 30.0 mm/h) were determined via multiple variable logistic regression. Results: Patients undergoing shoulder arthroplasty for osteoarthritis had an ESR (mean ± SD) of 22.6 ± 17.8, with 29.8% of patients elevated, and a CRP of 6.5 ± 6.4, with 25.5% of patients elevated. Arthroplasty for acute fracture and prosthetic joint infection (PJI) had higher preoperative ESR and CRP values. Multivariate analysis identified several predictors of elevated ESR, including infection, acute fracture, diabetes, and female sex. It also identified predictors of elevated CRP, including infection, acute fracture, and younger age. Conclusions: Preoperative ESR and CRP values may be elevated in 25% to 30% of patients undergoing primary shoulder arthroplasty. Arthroplasty for both acute fracture and PJI, along with several other patient factors, was associated with elevated preoperative ESR and CRP. Thus, routine collection of ESR and CRP preoperatively may not be of benefit, as elevated values are common. Further study is warranted.

Keywords

ESR CRP shoulder arthroplasty periprosthetic joint infection TSA rTSA

Get full access to this article

View all access options for this article.

References

Ali

Abbasi

Amjad

Saleem

Erythrocyte sedimentation rate and C-reactive protein as marker of acute versus chronic medical conditions. J Ayub Med Coll Abbottabad. 2019;31(1):39–45.

Bingham

Hassebrock

Christensen

Beauchamp

Clarke

Spangehl

Screening for periprosthetic joint infections with ESR and CRP: the ideal cutoffs. J Arthroplasty. 2019;35(5):1351–1354. https://doi.org/10.1016/j.arth.2019.11.040.

Carter

Mikuls

Nayak

Fehringer

Michaud

Impact of total shoulder arthroplasty on generic and shoulder-specific health-related quality-of-life measures: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94(17):e127. https://doi.org/10.2106/jbjs.k.00204.

Day

Lau

Ong

Williams

Ramsey

Kurtz

SM.

Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg. 2010;19(8):1115–1120. https://doi.org/10.1016/j.jse.2010.02.009.

Deshmukh

Koris

Zurakowski

Thornhill

TS.

Total shoulder arthroplasty: long-term survivorship, functional outcome, and quality of life. J Shoulder Elbow Surg. 2005;14(5):471–479. https://doi.org/10.1016/j.jse.2005.02.009.

Dodson

Craig

Cordasco

, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg. 2010;19(2):303–307. https://doi.org/10.1016/j.jse.2009.07.065.

Egglestone

Ingoe

Rees

Thomas

Jeavons

Rangan

Scoping review: diagnosis and management of periprosthetic joint infection in shoulder arthroplasty. Shoulder Elbow. 2019;11(3):167–181. https://doi.org/10.1177/1758573218779076.

Everhart

Bishop

Barlow

JD.

Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(11):1922–1930. https://doi.org/10.1016/j.jse.2017.04.006.

Fedewa

Hathaway

Ward-Ritacco

CL.

Effect of exercise training on C reactive protein: a systematic review and meta-analysis of randomised and non-randomised controlled trials. Br J Sports Med. 2017;51(8):670–676. https://doi.org/10.1136/bjsports-2016-095999.

10.

Fincher

Page

MI.

Clinical significance of extreme elevation of the erythrocyte sedimentation rate. Arch Intern Med. 1986;146(8):1581–1583.

11.

Garrigues

Zmistowski

Cooper

Green

Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: evaluation of periprosthetic shoulder infection. J Shoulder Elbow Surg. 2019;28(suppl 6):S32–S66. https://doi.org/10.1016/j.jse.2019.04.016.

12.

Garrigues

Zmistowski

Cooper

Green

Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: the definition of periprosthetic shoulder infection. J Shoulder Elbow Surg. 2019;28(suppl 6):S8–S12. https://doi.org/10.1016/j.jse.2019.04.034.

13.

Grosso

Frangiamore

Ricchetti

Bauer

Iannotti

JP.

Sensitivity of frozen section histology for identifying Propionibacterium acnes infections in revision shoulder arthroplasty. J Bone Joint Surg Am. 2014;96(6):442–447. https://doi.org/10.2106/jbjs.m.00258.

14.

Grosso

Frangiamore

Saleh

, et al. Poor utility of serum interleukin-6 levels to predict indolent periprosthetic shoulder infections. J Shoulder Elbow Surg. 2014;23(9):1277–1281. https://doi.org/10.1016/j.jse.2013.12.023.

15.

Kanafani

Sexton

Pien

Varkey

Basmania

Kaye

KS.

Postoperative joint infections due to Propionibacterium species: a case-control study. Clin Infect Dis. 2009;49(7):1083–1085. https://doi.org/10.1086/605577.

16.

Kim

Wise

Zhang

Szabo

RM.

Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93(24):2249–2254. https://doi.org/10.2106/jbjs.j.01994.

17.

Landry

Docherty

Ouellette

Cartier

LJ.

Causes and outcomes of markedly elevated C-reactive protein levels. Can Fam Physician. 2017;63(6):e316–e323.

18.

Miller

Green

Robinson

Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (Clin Res Ed). 1983;286(6361):266. https://doi.org/10.1136/bmj.286.6361.266.

19.

Namdari

Nicholson

Abboud

, et al. Comparative study of cultures and next-generation sequencing in the diagnosis of shoulder prosthetic joint infections. J Shoulder Elbow Surg. 2019;28(1):1–8. https://doi.org/10.1016/j.jse.2018.08.048.

20.

Nelson

Davis

Namdari

Outcomes in the treatment of periprosthetic joint infection after shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2016;25(8):1337–1345. https://doi.org/10.1016/j.jse.2018.08.048.

21.

Nestel

AR.

ESR adaptation for age: a forgotten pearl. BMJ. 2012;344:e1403. https://doi.org/10.1136/bmj.e1403.

22.

Neumaier

Metak

Scherer

MA.

C-reactive protein as a parameter of surgical trauma: CRP response after different types of surgery in 349 hip fractures. Acta Orthop. 2006;77(5):788–790. https://doi.org/10.1080/17453670610013006.

23.

Neumaier

Scherer

MA.

C-reactive protein levels for early detection of postoperative infection after fracture surgery in 787 patients. Acta Orthop. 2008;79(3):428–432. https://doi.org/10.1080/17453670710015355.

24.

Niskanen

Korkala

Pammo

Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg Br. 1996;78(3):431–433.

25.

Parvizi

Tan

Goswami

, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309–1314.e2. https://doi.org/10.1016/j.arth.2018.02.078.

26.

Paxton

Green

Krueger

VS.

Periprosthetic infections of the shoulder: diagnosis and management. J Am Acad Orthop Surg. 2019;27(21):e935–e944. https://doi.org/10.5435/jaaos-d-18-00232.

27.

Perez-Prieto

Portillo

Puig-Verdie

, et al. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop. 2017;41(7):1315–1319. https://doi.org/10.1007/s00264-017-3430-5.

28.

Piper

Fernandez-Sampedro

Steckelberg

, et al. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PLoS ONE. 2010;5(2):e9358. https://doi.org/10.1371/journal.pone.0009358.

29.

Piper

Jacobson

Cofield

, et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol. 2009;47(6):1878–1884. https://doi.org/10.1128/jcm.01686-08.

30.

Schoch

Schleck

Cofield

Sperling

JW.

Shoulder arthroplasty in patients younger than 50 years: minimum 20-year follow-up. J Shoulder Elbow Surg. 2015;24(5):705–710. https://doi.org/10.1016/j.jse.2014.07.016.

31.

Schwartz

Savin

Youderian

Mossad

Goldberg

BA.

National trends and perioperative outcomes in primary and revision total shoulder arthroplasty: trends in total shoulder arthroplasty. Int Orthop. 2015;39(2):27127–27126. https://doi.org/10.1007/s00264-014-2614-5.

32.

Shearn

Kang

IY.

Effect of age and sex on the erythrocyte sedimentation rate. J Rheumatol. 1986;13(2):297–298.

33.

Shih

Yang

. Erythrocyte sedimentation rate and C-reactive protein values in patients with total hip arthroplasty. Clin Orthop Relat Res. 1987(225):238–246.

34.

Siemons

Ten Klooster

Vonkeman

van Riel

Glas

van de Laar

MA.

How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis. BMC Musculoskelet Disord. 2014;15:368. https://doi.org/10.1186/1471-2474-15-368.

35.

Torrens

Santana

Mari

Puig

Alier

Serum C-reactive protein in patients undergoing elective shoulder arthroplasty. Prospective study. J Orthop Sci. 2017;22(5):858–861. https://doi.org/10.1016/j.jos.2017.06.005.

36.

Villacis

Sivasundaram

Pannell

Heckmann

Omid

Hatch

III . Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years. J Shoulder Elbow Surg. 2016;25(6):927–935. https://doi.org/10.1016/j.jse.2015.10.012.

37.

Wener

Daum

McQuillan

GM.

The influence of age, sex, and race on the upper reference limit of serum C-reactive protein concentration. J Rheumatol. 2000;27(10):2351–2359.

38.

White

Kelly

Dunsmuir

C-reactive protein level after total hip and total knee replacement. J Bone Joint Surg Br. 1998;80(5):909–911.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

7.77 MB