Predicting the disaster - The role of CRP in acetabular surgery

Clinical Efficacy of Bilateral Decompression Using Biportal Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases

OBJECTIVE

The study purpose was to compare unilateral biportal endoscopic lumbar interbody fusion (ULIF) with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative diseases in terms of surgical trauma and short-to medium-term postoperative results.

METHODS

Forty-nine patients with lumbar degenerative diseases (25 underwent ULIF, 24 underwent MIS-TLIF) who were treated between May 2019 and October 2021, were included in this retrospective analysis. We compared the 2 groups' blood loss, serum C-reactive protein (CRP), visual analog scale (VAS) scores for low back and leg pain, and the Oswestry Disability Index (ODI) score and slip percentage (SP). The modified Macnab score was obtained at the last follow-up.

RESULTS

On the postoperative day, the CRP levels (P < 0.05) were considerably lower in the ULIF group than those in the MIS-TLIF group. In addition, the ULIF group had significantly decreased intraoperative blood loss (P = 0.00) and postoperative blood loss (P = 0.00). After surgery, there was significant improvement in both groups in the VAS scores for low back and leg pain and in the ODI scores (P < 0.05). Two weeks after surgery, the ODI and VAS scores for low back pain of the ULIF group were considerably lower than those of the MIS-TLIF group (P < 0.05). The excellent and good rates of the Macnab criteria between the 2 groups were not significantly different at the last follow-up (P = 0.95).

CONCLUSIONS

The ULIF technique can effectively treat short-segment lumbar degenerative diseases and is a feasible alternative to the traditional minimally invasive surgery.

A nomogram for predicting post-operative wound complications after open reduction and internal fixation for calcaneal fractures

The purpose of our study was to determine the risk factors for post-operative wound complications (PWCs) after open reduction and internal fixation (ORIF) for calcaneal fracture and establish a nomogram prediction model. We retrospectively analysed the clinical data of patients who suffered from calcaneal fractures and had been surgically treated for ORIF in our institution between January 2010 and January 2020. Perioperative information was obtained through the electronic medical record system, univariate and multivariate analyses were performed to determine the risk factors of PWCs, and a nomogram model was constructed to predict the risk of PWCs. The predictive performance and consistency of the model were evaluated by the Hosmer -Lemeshow (H-L) test and the calibration curve. In total, 444 patients were enrolled in our study. Multivariate analysis results showed that smoking, limb swelling, angle of incision, and CRP were independent risk factors for skin necrosis. The AUC value for skin necrosis risk was 0.982 (95%CI 0.97-0.99). The H-L test revealed that the normogram prediction model had good calibration ability (P = .957). Finally, we found a correlation between PWCs and smoking, limb swelling, angle of incision, and CRP after ORIF for calcaneal fracture patients. Our nomogram prediction model might be helpful for clinicians to identify high-risk patients, as interventions could be taken early to reduce the incidence of PWCs.

Predicting the Exception-CRP and Primary Hip Arthroplasty

BACKGROUND

While primary hip arthroplasty is the most common operative procedure in orthopedic surgery, a periprosthetic joint infection is its most severe complication. Early detection and prediction are crucial. In this study, we aimed to determine the value of postoperative C-reactive protein (CRP) and develop a formula to predict this rare, but devastating complication.

METHODS

We retrospectively evaluated 708 patients with primary hip arthroplasty. CRP, white blood cell count (WBC), and several patient characteristics were assessed for 20 days following the operative procedure.

RESULTS

Eight patients suffered an early acute periprosthetic infection. The maximum CRP predicted an infection with a sensitivity and specificity of 75% and 56.9%, respectively, while a binary logistic regression reached values of 75% and 80%. A multinominal logistic regression, however, was able to predict an early infection with a sensitivity and specificity of 87.5% and 78.9%. With a one-phase decay, 71.6% of the postoperative CRP-variance could be predicted.

CONCLUSION

To predict early acute periprosthetic joint infection after primary hip arthroplasty, a multinominal logistic regression is the most promising approach. Including five parameters, an early infection can be predicted on day 5 after the operative procedure with 87.5% sensitivity, while it can be excluded with 78.9% specificity.