Periprosthetic infection risks and predictive value of C-reactive protein / albumin ratio for total joint arthroplasty Periprosthetic infection risks and value of C-reactive protein / albumin ratio

Main Article Content

Şeyhmus Yigit
Mehmet Sait Akar
Mehmet Akif Şahin
Hüseyin Arslan


CRP/ albumin ratio, periprosthetic infection, risk factors, total joint arthroplasty


Background and aim: There are no gold standard markers to estimate the risk of developing periprosthetic infections. Our aim is to compare the risks of periprosthetic infection in patients with THA and THA and to investigate the predictive significance of the CRP / albumin ratio.

Methods: This is a retrospective study containing data from 241 osteoarthritis patients and 19 patients with periprosthetic infections who underwent TKA and THA in our hospital from January 2014 to January 2019.12 risk factors(CRP/ albumin, albumin, CRP, age, gender, BMI, DM, ASA, nasal culture, urine culture, hospital stay, operation time) were analyzed.

Results: In the binary logistic regression model and multivariate regression analysis, the rate of CRP / albumin was 17.161 times higher than the patients with ≤0.16 cut-off value. (CRP / albumin ratio (odds ratio (OR) = 17.16, 95% CI: 1.55-189.03, P: 0.02). High BMI increased the risk of periprosthetic infection 1.3 times. Nasal bacterial colonization (OR = 0.99, 95% CI: 0.868-1.38, P: 0.7) and bacterium in urine (OR = 0.502, 95% CI: 0.07-3.598, P: 0.703) did not pose a significant risk for periprosthetic infection.

Conclusion: According to our findings, the CRP / albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. CRP / albumin ratio is a cheap and easy to apply marker. Routine urine and nasal bacteria screening is not required before total joint arthroplasty.


Download data is not yet available.
Abstract 100 | PDF Downloads 58


1. Otto-Lambertz C, Yagdiran A, Wallscheid F, Eysel P, Jung N. Periprosthetic infection in joint replacement. Dtsch Arztebl Int. 2017; 114:347–53.
2. Kurtz SM, Ong K, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res, 468 (2010), pp. 52-56
3. Jahoda D, Nyc O, Simsa J, Kucera E, Hanek P, Chrz P, Pokorný D, Tawa, N, Landor, I, Sosna A. Late hematogenous infection of prosthetic joints in our patients and proposal for a system of prevention. Acta Chir Orthop Traumatol Cech 2007; 74:397-400.
4. Jämsen E, Nevalainen P, Eskelinen A, et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Jt Surg Am.2012; 94:e101.
5. Kluytmans J, Van Belkum A, Verburg H. Nasal carriage of S.aureus. Epidemiology, underlying mechanisms and associated risk .Clin Microbiol Rev, 1997; 10 (3): 505-20.
6. Weiser M.C., Moucha C.S. The current state of screening and decolonization for the prevention of Staphylococcus aureus surgical site infection after total hip and knee arthroplasty. J Bone Joint Surg Am. 2015;97:1449–1458.
7. Cordero-Ampuero J, M. de Dios.What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties? Clin Orthop Relat Res, 468 (2010), pp. 3268-3277
8. Matowicka-Karna J. Markers of inflammation, activation of blood platelets and coagulation disorders in inflammatory bowel diseases. Postepy Hig Med Dosw(Online) 2016;70:305- 312
9. Goh SL, De Silva RP, Dhital K, Gett RM. Is low serum albumin associated with postoperative complications in patients under-going oesophagectomy for oesophageal malignancies? Interact Cardiovasc Thorac Surg 2015;20:107-113.
10. Parvizi J, Gehrke T; International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29 (7):1331.
11. Trampuz A, Widmer AF. Infections associated with orthopedic implants.Curr Opin Infect Dis2006;19 (4):349e56
12. Arampatzis S, Frauchiger B, Fiedler GM, Leichtle AB, Buhl D, Schwarz C, et al. Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission. Am J Med 2012;125:1125.e1-1125.
13. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27:302–45.
14. Iwata M, Kuzuya M, Kitagawa Y, A. Iguchi. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clin Exp Res, 18 (4) (2006), pp. 307-311
15. Greene KA, Wilde AH, Stulberg BN. Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications. J Arthroplasty. 1991; 6(4):321–325
16. R. Huang, M. Greenky, G.J. Kerr, et al. The effect of malnutrition on patients undergoing elective joint arthroplasty
J Arthroplasty, 28 (8) (2013), p. 21
17.Takahashi M, Naito K, Abe M, Sawada T, Nagano A. Relationship between radiographic grading of osteoarthritis and the biochemical markers for arthritis in knee osteoarthritis. Arthritis Res Ther. 2004; 6(3):R208–R212.
18. Windisch C, Brodt S, Roehner E, Matziolis G (2017) C-reactive protein course during the first 5 days after total knee arthroplasty cannot predict early prosthetic joint infection. Arch Orthop Trauma Surg 137:1115–1119
19.Fairclough E, Cairns E, Hamilton J, Kelly C (2009) Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med 9: 30–33
20.Sierros R, Fleming, M. Cascioli, T. Brady. The prognostic value of C-reactive protein in long-term care patients requiring prolonged mechanical ventilation
Chron Respir Dis, 6 (3) (2009), pp. 149-155
21. Zhang F, Ying L, Jin J, et al. The C-reactive protein/albumin ratio predicts long-term outcomes of patients with operable non-small cell lung cancer. Oncotarget 2017; 8:8835–42.
22. Iwata M, Kuzuya M, Kitagawa Y, Iguchi A. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clin Exp Res, 18 (4) (2006), pp. 307-311
23.Kobayashi Y, Inose H, Ushio S, Yuasa M, Hirai T, Yoshii T, Okawa A. Body Mass Index and Modified Glasgow Prognostic Score Are Useful Predictors of Surgical Site Infection After Spinal Instrumentation Surgery: A Consecutive Series. Spine (Phila Pa 1976). 2020 Feb 1; 45(3):E148-E154
24. Skråmm AE, Fossum Moen A, Arøen G. Bukholm. Surgical site infections in orthopaedic surgery demonstrate clones similar to those in orthopaedic Staphylococcus aureus nasal carriers.J Bone Joint Surg Am, 96 (2014), pp. 882-888
25.Xingyang Zhu , Xiaobo Sun , Yuqing Zeng, Wenjun Feng, Jie Li , Jianchun Zeng , Yirong Zeng. Can Nasal Staphylococcus Aureus Screening and Decolonization Prior to Elective Total Joint Arthroplasty Reduce Surgical Site and Prosthesis-Related Infections? A Systematic Review and Meta-Analysis. J Orthop Surg Res.2020 Feb 19;15(1):60.
26. Singh H , Simon Thomas, Shekhar Agarwal, Subhash C Arya, Shekhar Srivastav, Naresh Agarwal. Total Knee Arthroplasty in Women With Asymptomatic Urinary Tract Infection J Orthop Surg (Hong Kong) 2015 Dec; 23 (3):298-300
27. Honkanen M, Jamsen E, Karppelin M, Huttunen R, Huhtala H, et al.The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow up.Clin Microbiol Infect, 24 (2017), pp. 376-380)
28. Martinez-Velez D, Gonzalez-Fernandez E, Esteban J, Cordero-Ampuero J. Prevalence of asymptomatic bacteriuria in knee arthroplasty patients and subsequent risk of prosthesis infection.Eur J Orthop Surg Traumatol, 26 (2016), pp. 209-214
29. Si HB, Zeng Y, Shen B, et al. The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc : Off J ESSKA. 2015; 23(6):1824–1832.
30. Momohara S, Kawakami K, Iwamoto T, Yono K, Sakuma Y, Hiroshima R, Imamura H, Masuda I, Tokita A, Ikari K. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol 2011; 21:469-75
31. Claus A, Asche G, Brade J, et al. [Risk profiling of postoperative complications in 17,644 total knee replacements]. Der Unfallchirurg. 2006; 109(1):5–12.
32.Namba RS, Inacio MC, Paxton EW (2013) Risk factors associated with deep surgical site infections after primary total knee arthroplasty. J Bone Jt Surg Am 95:775–782