JOA - 2026-05-22 - Journal Article
C-Reactive Protein and Fibrinogen Dynamics are Predictors of Reinfection Risk after Explantation in Two-Stage Periprosthetic Joint Revision.
Straub J, Willmann L, Staats K, Windhager R, Böhler C
Topics
Key Takeaway
Relative fibrinogen trajectory after explantation predicts early two-stage revision failure with an AUC of 0.75 (sensitivity 0.81, specificity 0.70), outperforming CRP.
Summary Depth
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Summary
This study asked whether early postoperative CRP and fibrinogen kinetics after explantation predict treatment failure in two-stage PJI revision. Using propensity score-matched cohorts of 72 failures vs. 72 successes from 288 two-stage THA/TKA revisions, serial biomarker levels were measured preoperatively and on postoperative days 1, 3, and 5. Relative fibrinogen change yielded the highest predictive value (AUC 0.75, sensitivity 0.81, specificity 0.70), with significant between-group differences in absolute CRP preoperatively and on day 1, and fibrinogen on days 1 and 3.
Key Limitation
The optimal fibrinogen threshold triggering clinical intervention is not defined, limiting direct protocol implementation despite the reported AUC.
Original Abstract
BACKGROUND
This study aimed to evaluate early postoperative changes in C-reactive protein (CRP) and fibrinogen after explantation in two-stage revision surgeries and their potential to predict early treatment failure.
METHODS
A total of 288 patients who underwent a two-stage exchange of their total hip arthroplasty (THA) or total knee arthroplasty (TKA) from June 2012 to September 2023 were retrospectively identified. A periprosthetic joint infection (PJI) was diagnosed based on European Bone and Joint Infection Society (EBJIS) criteria. Patients were categorized into two groups: those who did not have failure and those who had early failure within the first year. The two equally sized groups of 72 patients were created through propensity score matching. Absolute and relative CRP and fibrinogen levels and their trajectories were compared based on preoperative values and postoperative on days one, three, and five postoperatively. Furthermore, receiver operating characteristic (ROC) analysis was conducted.
RESULTS
Significant differences in absolute CRP were observed preoperatively (P = 0.03) and on postoperative day 1 (P = 0.01). Fibrinogen showed significant differences on days one (P = 0.01) and three (P = 0.01). Relative and absolute CRP changes differed significantly on day three, while fibrinogen changes were significant on day five. The area under the curve of relative fibrinogen values demonstrated the highest prognostic value for early failure with an area under the curve (AUC) of 0.75 (sensitivity = 0.81, specificity = 0.70).
CONCLUSION
This study was the first to specifically examine early postoperative changes in CRP and fibrinogen following explantation in two-stage revision arthroplasty, highlighting the superior prognostic value of fibrinogen compared to CRP in terms of early failure. In particular, monitoring early relative fibrinogen changes may help identify patients at risk of early failure and support timely clinical decision-making.