Evaluation of the Normal Range of C-reactive Protein and Erythrocyte Sedimentation Rate Serum Level after Total Knee Arthroplasty and Total Hip Arthroplasty in Osteoarthritis Patients without Complications

Abstract

Aims: Infection is one of the most serious complications of joint replacement surgeries. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) serum levels are widely used for the evaluation of acute infections after joint replacement surgeries. The aim of our study is to determine normal changes in these inflammatory mediators after total hip arthroplasty (THA) and total knee arthroplasty (TKA).
 Methodology: In our study, we enrolled 100 patients with mean age of 68 y/o (57–77) and the diagnosis of primary osteoarthritis who underwent joint replacement surgery. ESR and CRP serum levels were measured before surgery, as well as one, three, and five days after surgery and then again 14, 42, and 90 days after surgery. The results were compared in two groups of TKA and THA, and patients who had undergone THA were further divided into cemented and uncemented groups.
 Results: The CRP serum level increased rapidly and reached its maximum level (130.47) on the third day after surgery and returned to its pre-surgery level at the end of three months in all patients. The ESR serum level reached its peak (142.65) on the fifth day after surgery and then decreased; however, it was still slightly higher than the pre-surgery levels at the end of three months. CRP showed faster and more remarkable level changes following surgery compared to ESR, and this elevation was unrelated to the pre-surgery levels. No significant difference was observed between the cemented and uncemented groups.
 Conclusion: Changes in CRP and ESR levels after TKA and THA surgeries are reliable indicators for assessment of prosthetic infections. In cases with an elevated CRP serum level on the third day of surgery, a strong suspicion of infection seems completely rational.