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Introdução: As infeções articulares periprótéticas constituem complicações relevantes após artroplastias da anca e do joelho, cujo diagnóstico precoce é fundamental para otimizar o prognóstico. A proteína C reativa (PCR) sérica é o biomarcador mais utilizado; contudo, a sua interpretação no pós-operatório é desafiante. Objetivo: Avaliar o valor preditivo dos níveis de PCR às 72 horas após artroplastias totais primárias da anca (ATPA) e do joelho (ATPJ), no desenvolvimento de infeções periprótésicas precoces (≤ seis semanas). Metodologia: Estudo retrospetivo caso-controlo, com 336 potenciais doentes submetidos a ATPA ou ATPJ. Procedeu-se à análise de registos clínicos e laboratoriais, com especial enfoque na PCR às 72 horas. Após aplicação dos critérios de elegibilidade, os participantes foram divididos em dois grupos: casos (infeções até à 6ª semana) e controlos (sem complicações). Em virtude da dimensão amostral, foram aplicados aos valores de PCR pontos de corte descritos na literatura (ATPA≥15,2 mg/dL e ATPJ≥16,8 mg/dL). Resultados: Nas ATPJ (n=13), os casos (n=6) apresentaram uma média de PCR de 24,0 mg/dL, enquanto os controlos (n=7) registaram uma média de 15,1 mg/dL. Nas ATPA (n=6), os casos (n=4) apresentaram uma média de 12,9 mg/dL de PCR, enquanto os controlos (n=2) exibiram uma média de 11,8 mg/dL. A aplicação de pontos de corte aumentou a especificidade, mas reduziu a sensibilidade, resultando na reclassificação de alguns doentes. Discussão: Embora limitada a uma análise descritiva de associação exploratória, a aplicação de pontos de corte conferiu maior interpretabilidade clínica aos resultados. Valores elevados de PCR às 72 horas foram observados em pacientes com infeção desenvolvida até à 6ª semana após ATPJ. Conclusão: Não foi possível demonstrar o valor preditivo da variável em estudo; no entanto, este estudo sugere uma associação entre o desenvolvimento de infeção periprótésica precoce e os níveis séricos de PCR às 72 horas mais elevados, nomeadamente após ATPJ.
ABSTRACT Introduction: Periprosthetic joint infections are significant complications following hip and knee arthroplasty, and early diagnosis is essential to optimise prognosis. Serum C-reactive protein (CRP) is the most widely used biomarker, but its interpretation in the postoperative period remains challenging. Objective: To evaluate the predictive value of CRP levels 72hours after primary total hip arthroplasty (THA) or primary total knee arthroplasty (TKA) in the development of early periprosthetic infections (≤ six weeks). Methodology: Retrospective case-control study with 336 potential patients undergoing THA or TKA. Clinical and laboratory records were analysed, with a special focus on CRP at 72hours. After applying the eligibility criteria, participants were divided into two groups: cases (infections up to the 6th week) and controls (no complications). Due to the sample size, cut-off points described in the literature (THA≥15.2 mg/dL and TKA≥16.8 mg/dL) were applied to the CRP values. Results: In TKA (n=13), cases (n=6) had a mean CRP of 24.0 mg/dL, while controls (n=7) had a mean of 15.1 mg/dL. In THA (n=6), cases (n=4) had a mean CRP of 12.9 mg/dL, while controls (n=2) had a mean of 11.8 mg/dL. The application of cut-off points increased specificity but reduced sensitivity, resulting in the reclassification of some patients. Discussion: Although it was limited to a descriptive analysis of exploratory associations, the application of cut-off points provided greater clinical interpretability to the results. Elevated CRP levels at 72 hours were observed in patients who developed infection within the first six weeks after TKA. Conclusion: While it was not possible to demonstrate the predictive value of the variable under study, this study does suggest an association between the development of early periprosthetic infection and higher serum CRP levels after 72 hours, particularly following TKA.
ABSTRACT Introduction: Periprosthetic joint infections are significant complications following hip and knee arthroplasty, and early diagnosis is essential to optimise prognosis. Serum C-reactive protein (CRP) is the most widely used biomarker, but its interpretation in the postoperative period remains challenging. Objective: To evaluate the predictive value of CRP levels 72hours after primary total hip arthroplasty (THA) or primary total knee arthroplasty (TKA) in the development of early periprosthetic infections (≤ six weeks). Methodology: Retrospective case-control study with 336 potential patients undergoing THA or TKA. Clinical and laboratory records were analysed, with a special focus on CRP at 72hours. After applying the eligibility criteria, participants were divided into two groups: cases (infections up to the 6th week) and controls (no complications). Due to the sample size, cut-off points described in the literature (THA≥15.2 mg/dL and TKA≥16.8 mg/dL) were applied to the CRP values. Results: In TKA (n=13), cases (n=6) had a mean CRP of 24.0 mg/dL, while controls (n=7) had a mean of 15.1 mg/dL. In THA (n=6), cases (n=4) had a mean CRP of 12.9 mg/dL, while controls (n=2) had a mean of 11.8 mg/dL. The application of cut-off points increased specificity but reduced sensitivity, resulting in the reclassification of some patients. Discussion: Although it was limited to a descriptive analysis of exploratory associations, the application of cut-off points provided greater clinical interpretability to the results. Elevated CRP levels at 72 hours were observed in patients who developed infection within the first six weeks after TKA. Conclusion: While it was not possible to demonstrate the predictive value of the variable under study, this study does suggest an association between the development of early periprosthetic infection and higher serum CRP levels after 72 hours, particularly following TKA.
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Artroplastia total Infeção periprotésica Período pós-operatório precoce Marcadores inflamatórios Proteína C reativa Total arthroplasty Periprosthetic infection Early postoperative period Inflammatory markers C-reactive protein MGATS