Evaluation of Fever and Its Related Factors during 4 Weeks after Primary Total Hip Arthroplasty


The purpose of this study was to describe the incidence and characteristics of postoperative fever (POF; ≥38) and clarify the correlation between POF and febrile-related factors during 4 weeks after primary total hip arthroplasty (THA). A total of 56 patients were included in the study (67 THAs). The preoperative diagnosis for all patients was osteoarthritis. The average follow-up period was 90 months. No patients developed deep infection during the follow-up period. The maximum mean peak daily temperature was 37.7 on the day of the surgery and the next day. Fifty-two percent of patients experienced POF, with most developing a maximum temperature (MT) on the day of surgery and the latest occurring by postoperative day (POD) 3. Only C-reactive protein (R = 0.384, p = 0.001) among the febrile-related factors had a weak correlation with MT. Four hips showed a POF of >38 later than POD 7; all four of these patients were diagnosed with a urinary tract infection. POF is common and may be part of a normal inflammatory response to tissue injury after THA. More than half of patients may develop POF within 1 week, with most developing MT on POD 0 and the latest occurring by POD 3. In addition, urinary tract infections might be an initial reason for POF in the subsequent 3 weeks.

Share and Cite:

Ishii, Y. , Noguchi, H. , Takeda, M. , Sato, J. , Yamamoto, T. and Domae, Y. (2013) Evaluation of Fever and Its Related Factors during 4 Weeks after Primary Total Hip Arthroplasty. Surgical Science, 4, 1-6. doi: 10.4236/ss.2013.41001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. Athanassious, A. Samad, A. Avery, J. Cohen and D. Chalnick, “Evaluation of Fever in the Immediate Postoperative Period in Patients Who Underwent Total Joint Arthroplasty,” Journal of Arthroplasty, Vol. 26, No. 8, 2011, pp. 1404-1408. doi:10.1016/j.arth.2011.02.019
[2] A. P. Czaplicki, J. E. Borger, J. R. Politi, B. T. Chambers and B. C. Taylor, “Evaluation of Postoperative Fever and Leukocytosis in Patients after Total Hip and Knee Arthroplasty,” Journal of Arthroplasty, Vol. 26, No. 8, 2011, pp. 1387-1389. doi:10.1016/j.arth.2010.12.024
[3] J. A. Shaw and R. Chung, “Febrile Response after Knee and Hip Arthroplasty,” Clinical Orthopaedics and Related Research, Vol. 367, 1999, pp. 181-189. doi:10.1097/00003086-199910000-00022
[4] P. C. Summersell, A. Turnbull, G. Long, et al., “Temperature Trends in Total Hip Arthroplasty: A Retrospective Study,” Journal of Arthroplasty, Vol. 18, No. 4, 2003, pp. 426-429. doi:10.1016/S0883-5403(03)00015-9
[5] D. T. Ward, E. N. Hansen, S. K. Takemoto and K. J. Bozic, “Cost and Effectiveness of Postoperative Fever Diagnostic Evaluation in Total Joint Arthroplasty Patients,” Journal of Arthroplasty, Vol. 25, No. 6, 2010, pp. 43-48.
[6] K. J. Bozic and M. D. Ries, “The Impact of Infection after Total Hip Arthroplasty on Hospital and Surgeon Resource Utilization,” Journal of Bone and Joint Surgery, Vol. 87, No. 8, 2005, pp. 1746-1751. doi:10.2106/JBJS.D.02937
[7] A. D. Toms, D. Davidson, B. A. Masri and C. P. Duncan, “The Management of Peri-Prosthetic Infection in Total Joint Arthroplasty,” Journal of Bone and Joint Surgery, Vol. 88, No. 2, 2006, pp. 149-155. doi:10.1302/0301-620X.88B2.17058
[8] R. B. Gustilo and L. A. C. Leagogo, “Management of Infected Total Hip Replacement. Orthopaedic Infection. Diagnosis and Treatment,” WB Saunders, Philadelphia, 1989, pp. 224-233.
[9] S. Mitsuyasu, A. Hagihara, H. Horiguchi and K. Nobutomo, “Relationship between Total Arthroplasty Case Volume and Patient Outcome in an Acute Care Payment System in Japan,” Journal of Arthroplasty, Vol. 21, No. 5, 2006, pp. 656-663. doi:10.1016/j.arth.2005.09.007
[10] Y. Ishii, H. Noguchi, M. Takeda, J. Sato and Y. Domae, “Efficacy of an Abduction Brace in Preventing Initial Dislocation in the Early Postoperative Period after Primary Total Hip Arthroplasty,” Surgical Science, Vol. 3, No. 3, 2012, pp. 131-135. doi:10.4236/ss.2012.33026
[11] B. M. Andres, D. D. Taub, I. Gurkan and J. F. Wenz, “Postoperative Fever after Total Knee Arthroplasty: The Role of Cytokines,” Clinical Orthopaedics and Related Research, Vol. 415, 2003, pp. 221-231. doi:10.1097/01.blo.0000093914.26658.55
[12] J. G. Kennedy, W. B. Rodgers, D. Zurakowski, et al., “Pyrexia after Total Knee Replacement. A Cause for Concern?” American Journal of Orthopaedics, Vol. 26, No. 8, 1997, pp. 549-552,554.
[13] J. White, M. Kelly and R. Dunsmuir, “C-Reactive Protein Level after Total Hip and Total Knee Replacement,” Journal of Bone and Joint Surgery, Vol. 80, No. 5, 1998, pp. 909-911. doi:10.1302/0301-620X.80B5.8708
[14] R. O. Niskanen, O. Korkala and H. Pammo, “Serum C-Reactive Protein Levels after Total Hip and Knee Arthroplasty,” Journal of Bone and Joint Surgery, Vol. 78, No. 3, 1996, pp. 431-433.
[15] J. B. Gross, “Estimating Allowable Blood Loss: Corrected for Dilution,” Anesthesiology, Vol. 58, No. 3, 1983, pp. 277-280. doi:10.1097/00000542-198303000-00016
[16] D. Schey, E. M. Salom, A. Papadia and M. Penalver, “Extensive Fever Workup Produces Low Yield in Determining Infectious Etiology,” American Journal of Obstetrics and Gynecology, Vol. 192, No. 5, 2005, pp. 1729-1734.
[17] M. Handel, J. Winkler, R. F. Homlein, et al., “Increased Interleukin-6 in Collected Drainage Blood after Total Knee Arthroplasty: An Association with Febrile Reactions during Retransfusion,” Acta Orthopaedica Scandinavica, Vol. 72, No. 3, 2001, pp. 270-272. doi:10.1080/00016470152846600
[18] A. F. Chen, M. K. Stewart, A. E. Hey and B. A. Klatt, “Effect of Immediate Postoperative Physical Therapy on Length of Stay for Total Joint Arthroplasty Patients,” Journal of Arthroplasty, Vol. 27, No. 6, 2012, pp. 851-856. doi:10.1016/j.arth.2012.01.011
[19] K. Juliano, D. Edwards, D. Spinello, et al., “Initiating Physical Therapy on the Day of Surgery Decreases Length of Stay without Compromising Functional Outcomes Following Total Hip Arthroplasty,” The Musculoskeletal Journal of Hospital for Special Surgery, Vol. 7, No. 1, 2011, pp. 16-20.
[20] L. Sanzén and A. S. Carlsson, “The Diagnostic Value of C-Reactive Protein in Infected Total Hip Arthroplasties,” Journal of Bone Joint Surgery, Vol. 71, No. 4, 1989, pp. 638-641.
[21] C. J. Della Valle, J. D. Zuckerman and P. E. Di Cesare, “Periprosthetic Sepsis,” Clinical Orthopaedic and Related Research, Vol. 420, 2004, pp. 26-31. doi:10.1097/00003086-200403000-00005
[22] M. A. Buttaro, I. Tanoira, F. Comba and F. Piccaluga, “Combining C-Reactive Protein and Interleukin-6 May Be Useful to Detect Periprosthetic Hip Infection,” Clinical Orthopaedic and Related Research, Vol. 468, No. 12, 2010, pp. 3263-3267. doi:10.1007/s11999-010-1451-0
[23] S. M. Frank, M. J. Kluger and S. L. Kunkel, “Elevated Thermostatic Setpoint in Postoperative Patients,” Anesthesiology, Vol. 93, No. 6, 2000, pp. 1426-1431. doi:10.1097/00000542-200012000-00014
[24] P. M. Faris, M. A. Ritter, E. M. Keating and C. R. Valer, “Unwashed Filtered Shed Blood Collected after Knee and Hip Arthroplasties,” Journal of Bone Joint Surgery, Vol. 73, No. 8, 1991, pp. 1169-1178.
[25] S. Kenan, M. Liebergall, E. Simchen and S. Porat, “Fever Following Orthopedic Operations in Children,” Journal of Pediatric Orthopaedics, Vol. 6, No. 2, 1986, pp. 139-142. doi:10.1097/01241398-198603000-00003

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.