Preoperative idiopathic CRP and ESR elevation increase the risk of PJI within 90-day after primary total knee arthroplasty in patients with osteoarthritis

Background: The purpose of this study was to determine the association between preoperative idiopathic serum CRP and ESR elevation in KOA patients with 90-day PJI after primary TKA. Methods: : We reviewed our center’s database over a 60-month study period from November 2016 to October 2021. After excluding those with known diseases that elevate CRP and ESR, 882 KOA patients who met the initial screening criteria, namely, 293 males and 589 females aged 67.00±7.91 (range, 43-91) years, were divided into four groups based on the preoperative CRP level and ESR: 44 patients, CRP+ESR+; 27 patients, CRP+ESR-; 176 patients, CRP-ESR+; and 635 patients, CRP-ESR-. All patients underwent primary TKA, and the prevalence of PJI was evaluated based on the 2014 MSIS acute diagnostic criteria. The risk factors for CRP and ESR elevation were analyzed by binary logistic regression. Results: : The total infection rate was 1.59% (14/882); infection rates in the CRP+ESR+, CRP+ESR-, CRP-ESR+ and CRP-ESR- groups were 6.82% (3/44), 0 (0/27), 2.27% (3/176), and 1.10% (7/635), respectively. There was a significant relationship between preoperative idiopathic ESR or CRP elevation and the prevalence of 90-day PJI (P=0.022). Diabetes mellitus (P=0.0004) and an elevated body mass index (BMI) (P<0.0001) were risk factors for CRP elevation; being female (P<0.0001) and having an elevated BMI (P<0.0001) or diabetes mellitus (P=0.0036) were risk factors for ESR elevation. Conclusion: Preoperative idiopathic CRP and/or ESR elevation increase the risk of 90-day PJI after primary TKA. Demographic characteristics and complications should be considered before deciding whether surgery can be performed, or additional perioperative treatment is needed to reduce the occurrence of PJI.