The Pattern of Procalcitonin in Primary Total Hip and Knee Arthroplasty and its Implication in Periprosthetic Infection

BACKGROUND: The serum marker Procalcitonin (PCT) has been shown to be a sensitive indicator of bacterial infection, but very little is known of its behavior in periprosthetic infection. In this study, PCT was compared with standard tests used to aid the diagnosis of infection. As a baseline, its pattern in uncomplicated hip and knee arthroplasty was investigated. METHODS: A prospective study of fifty-nine patients had bloods taken preoperatively, and on days 1, 3, 5, for PCT, C- reactive protein, erythrocyte sedimentation rate and white cell count. RESULTS: Fifty patients (85%) had normal PCT values (< 0.5 ng/ml) and only 5 recorded a value > 1.0ng/ml. On day 5 only 1 patient had a value > 0.5ng/ml. The standard tests all showed sporadic elevations over the 3 days. PCT levels are not significantly elevated by the trauma of this surgery, as they are in other surgical procedures. CONCLUSIONS: PCT may be very useful in patients with suspected periprosthetic infection. KEYWORDS: Infection; Periprosthetic; Procalcitonin; C-reactive protein; Arthroplasty