Relationship of C-reactive protein, erythrocyte sedimentation rate and knee skin temperature after total knee arthroplasty - prospective study
Abstract
Knee osteoarthritis is a common cause of severe pain and functional limitation. Total knee arthroplasty is an effective procedure to relieve pain, restore knee function, and improve quality of life for patients with end stage knee arthritis. The aim of this study was to investigate the inflammatory process in patients with primary knee osteoarthritis before surgery and in subsequent periods following total knee arthroplasty.A prospective study of 14 patients undergoing primary total knee replacements was conducted from October 2014 to May 2015 in our institution. The patients were evaluated by monitoring serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), knee skin temperature, and clinical status. Measurements were carried out preoperatively and postoperatively on day 2 and 2nd week, 6th week , 14th week and 24th week during follow-up review. The CRP was elevated on the 2nd postoperative day but fell to preoperative values at two weeks postoperatively. CRP returned to within the normal range by six weeks postoperatively. In addition, the postoperative ESR showed a slow rise with a maximum level at two weeks after surgery and returned to the within normal range at 14 weeks postoperatively. The difference in skin temperature between operated and contralateral knees had a mean value of 3.9C at two weeks. The mean value decreased to 3.4C at six weeks, 2.3C at 14 weeks, and 1.0C at 24 weeks. The difference in skin temperature decreased gradually and eventually there was no statistically significant difference at 24 weeks after surgery. A sustained elevation in serum CRP, ESR, and skin temperature must raise the concern of early complication and may suggest the development of postoperative complication such as haematoma and or infection.
Full Text:
PDFReferences
Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman BN, Aliabadi P (1995) The incidence and natural history of knee osteoarthritis in the elderly. Arthritis Rheum 38:1500–1505
Pepys MB (1981) C-reactive protein fifty years on. Lancet 1:653–657
Kushner I, Gewurz H, Benson MD (1981) C-reactive protein and the acute phase response. J Lab Clin Med 97:739–749
Kishimoto T (1989) The biology of interleukin-6. Blood 74:1–10 5. Walther Z, May LT, Sehgal PB (1988) Transcriptional regulation of the interferon-beta 2/B cell differentiation factor BSF-2/ hepatocyte-stimulating factor gene in human fibroblasts by other cytokines. J Immunol 140:974–977
Damas P, Reuter A, Gysen P, Demonty J, Lamy M, Franchimont P (1989) Tumor necrosis factor and interleukin-1 serum levels during severe sepsis in humans. Crit Care Med 17:975–978
Larsson S, Thelander U, Friberg S (1992) C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res 275:237–242
Niskanen RO, Korkala O, Pammo H (1996) Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg Br 78:431–433
Heinrich PC, Castell JV, Andus T (1990) Interleukin-6 and the acute phase response. Biochem J 265:621–636
Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122
Minetto MA, Oprandi G, Saba L, Mussino S, Aprato A, Massè A, Angeli A, Gallinaro P (2006) Serum interleukin-6 response to elective total hip replacement surgery. Int Orthop 30:172–176
Park KK, Kim TK, Chang CB, Yoon SW, Park KU (2008) Normative temporal values of CRP and ESR in unilateral and staged bilateral TKA. Clin Orthop Relat Res 466:179–188
Wirtz DC, Heller KD, Miltner O, Zilkens KW, Wolff JM (2000) Interleukin-6: a potential inflammatory marker after total joint replacement. Int Orthop 24:194–196
White J, Kelly M, Dunsmuir R (1998) C-reactive protein level after total hip and total knee replacement. J Bone Joint Surg Br 80:909–911
Niskanen RO, Korkala O, Pammo H (1996) Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg Br 78:431–433
Baigrie RJ, Lamont PM, Kwiatkowski D, Dallman MJ, Morris PJ (1992) Systemic cytokine response after major surgery. Br J Surg 79:757–760
Kragsbjerg P, Holmberg H, Vikerfors T (1995) Serum concen- trations of interleukin-6, tumour necrosis factor-alpha, and C- reactive protein in patients undergoing major operations. Eur J Surg 161:17–22
Moreschini O, Greggi G, Giordano MC, Nocente M, Margheritini F (2001) Postoperative physiopathological analysis of inflammatory parameters in patients undergoing hip or knee arthroplasty. Int J Tissue React 23:151–154
Bilgen O, Atici T, Durak K, Karaeminoullari BMS (2001) C- reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res 29:7–12
Larsson S, Thelander U, Friberg S (1992) C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res 275:237–242
Mehra A, Langkamer VG, Day A, Harris S, Spencer RF (2005) C reactive protein and skin temperature post total knee replacement. Knee 12:297–300
Haidar SG, Charity RM, Bassi RS, Nicolai P, Singh BK (2006) Knee skin temperature following uncomplicated total knee replacement. Knee 13:422–426
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
An Initiative of The Tamil Nadu Dr MGR Medical University