CRP (C Reactive Protein) level after total knee replacement in Indian population--- does it follow Anglo-Saxon trend?

Abstract

Background: This study was to determine how C-reactive protein (CRP) responds after total knee replacement (TKR), including both unilateral and simultaneous bilateral TKR in Indian population and if it follows Anglo-Saxon trend. Published literature from North America and Europe shows CRP value peaks on the 2nd post-operative day and drops to normal by 6-8 weeks. We started the study with null hypothesis. Material and methods: This is a prospective study, with 50 patients (all females, 25 received unilateral operations and 25 bilateral ones) included. CRP levels were measured, on the 2nd day, 8, 12 and 16 weeks after operation. Results: In both groups, CRP level rose the 2nd post-operative day. The rise in CRP level was significantly higher in the simultaneous bilateral TKR group than in the unilateral TKR group. In unilateral cases, CRP on the 2nd postoperative day ranged from 65 to 110 mg/l with average level of 80 mg/ml. In bilateral TKR cases, CRP level on the 2nd postoperative day was between 110 and 180 mg/l with a mean of 140 mg/ml. The CRP level returned to normal in about 40% of unilateral TKR patients 8 weeks after operation, while in 92% (23 out of 25) of bilateral simultaneous TKR patients it stayed at a high level 8 weeks post-op and did not come back to normal. At 12 weeks CRP decreased to normal in all 100% of unilateral TKR patients and 32% of bilateral TKR patients. At 16 weeks, CRP was normal in all bilateral TKR patients. Conclusion: 60% of our unilateral TKR patients and 92% of our simultaneous bilateral TKR patients did not achieve a normal CRP 8 weeks after operation. These findings are significant as CRP is commonly used as a very sensitive indicator of postoperative joint infection. Hence we conclude that in the Indian TKR patients the CRP values take longer time to return to normal than in their Anglo-Saxon counterparts. Published results regarding the normal levels of CRP in unilateral TKR should not be extrapolated to simultaneous bilateral TKR patients.

C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) Trends following Total Hip and Knee Arthroplasties in an Indian Population – A Prospective Study

“…In a study by Park et al 13 temporal values of CRP after TKR reached the normal reference at the end of 6th week. In another study by Londhe et al 14 , CRP levels after unilateral TKR reached the normal baseline level after 12 weeks and at the end of 16 weeks after bilateral TKR. In an analysis done on the Iranian population by Nazem et al 15 , CRP levels after TKR and THR did not reach the normal baseline values even after one year of the procedure.…”

“…Though there are numerous studies in the literature evaluating CRP and ESR trends post total hip and knee replacement surgeries, very few have actually evaluated the effect of the racial factors affecting CRP values 18 . Most of the studies have primarily been done on a subset of the european population 9 - 13 and to the best of the author's knowledge, very few have studied the early post-operative trend of CRP and ESR on a subset of Asian population 14 , 15 . The present study is an attempt to fill this gap in literature by evaluating the CRP and ESR trend in an Indian population.…”

“…While ESR continues to remain elevated for a longer duration in the post-operative period following a replacement surgery, CRP does follow a regular pattern with an immediate peak at 2nd post-operative day followed by a gradual decline over a period of time 9 , 12 , 13 . However, the time taken for the normalisation of CRP values to its pre-operative level may vary and differs among various studies involving different populations 14 , 15 . It is important to realise that a single CRP or ESR reading holds very limited value and that a trend must be observed to maximise its full usefulness.…”

Relationship Between Pre- and Post-Operative C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) With Post-Operative Pain After Total Hip and Knee Arthroplasty: An Observational Study

“…In our study, all 105 patients were in antibiotic coverage which might have influenced the response of inflammatory markers, hence similar results were not obtained. Londhe et al [ 18 ] concluded that in the Indian TKR patients, the CRP values take longer time to return to normal than in their Anglo-Saxon counterparts. Due to the variable nature of raised CRP, marginal elevations in CRP can be difficult to interpret and should not be utilized as an isolated test for the clinical picture.…”

“…H/o, history of; NLR, neutrophil-to-lymphocyte ratio; ANOVA, analysis of variance; COPD, chronic obstructive pulmonary disease; SD, standard deviation; TIA, transient ischemic attack results were not obtained. Londhe et al [18] concluded that in the Indian TKR patients, the CRP values take longer time to return to normal than in their Anglo-Saxon counterparts. Due to the variable nature of raised CRP, marginal elevations in CRP can be difficult to interpret and should not be utilized as an isolated test for the clinical picture.…”