Post-operative pyrexia and primary total hip replacement.

A M Khan J G Andrews P R Kay.

Orthopaedic Proceedings. Supplement of the Journal of Bone and Joint Surgery


Pyrexia in the post-operative setting has often been associated with a possible systemic or wound infection. We assessed whether there is any justification for our concern regarding post-operative pyrexia following hip arthroplasty and subsequent deep prosthetic infection.

An assessment of the clinical outcome of 97 sequential patients who underwent 103 primary hip arthroplasty for primary osteoarthritis replacements. Daily temperature and systemic complications in the post-operative period were recorded. Clinical outcome was measured using an Oxford hip questionnaire. Patients had a mean follow-up of 5.2 years (range 3.5–7.2years)

We reviewed the postoperative temperature records of 80 patients who had undergone primary total hip replacement. Thirty-one patients had required revision surgery at a mean time interval of 37.2 months (range 5–74 months) for confirmed deep prosthetic infection. The remaining Forty-nine patients were asymptomatic at a mean follow-up of 31.5 months.

Study 1: Post-operative pyrexia of 38 degrees Celsius was present in 51% of patients undergoing primary hip replacement in the first post-operative week but in 21.1% no etiological cause could be identified. Clinical outcome measured by an Oxford hip questionnaire was not influenced by the post-operative temperature pattern.

Study 2 : The mean peak temperature on the first post-operative day was significantly lower in patients with deep prosthetic infection then patients with a clinically normal outcome (p=0.01).

Post-operative pyrexia is clearly not uncommon following primary arthroplasty and its presence should not be regarded as detrimental. Pyrexia in the postoperative setting is a component of the acute phase response to trauma and study 2 demonstrates patients who develop a low-grade infection following arthroplasty may have a diminished febrile response to surgical trauma which may be an indirect representation of a diminished immune response to surgical trauma or infection