C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) play helpful roles in determining the presence of infection after TKA. To provide baseline values, we documented normative temporal values of CRP and ESR in unilateral and staged bilateral TKAs for osteoarthritis. Levels of CRP and ESR were evaluated before surgery and on the first, second, fifth, seventh, fourteenth, forty-second, and ninetieth postoperative days in 320 uncomplicated primary TKAs. C-reactive protein and ESR levels were compared in three groups: unilateral (108 knees), first knee bilateral (106 knees), and second knee bilateral (106 knees) groups. All three groups exhibited similar temporal patterns. Mean CRP levels increased rapidly, reaching a peak on the second day and decreased to less than the normal reference level on the forty-second day. They returned to preoperative levels on the ninetieth day. Mean ESR levels peaked on the fifth day and returned close to the preoperative levels only on the ninetieth day. Wide variations were observed and many cases (43%) did not follow the typical patterns. C-reactive protein had greater fold changes, less frequent atypical temporal patterns, and lower correlation between preoperative and postoperative levels than ESR. Our findings should help surgeons interpret CRP and ESR to determine the presence of infection after TKA.

Background TKA can involve substantial bleeding, and the issue regarding whether vacuum drainage should be used during TKA continues to be debated as both methods have disadvantages. Questions/purposes We therefore asked whether subcutaneous indwelling vacuum drainage is advantageous over intraarticular indwelling vacuum drainage in terms of blood drainage, bleeding-related complications, and functional outcomes in primary TKA. Patients and methods We randomized 111 patients undergoing TKAs to have either a subcutaneous indwelling or an intraarticular indwelling catheter and compared the two groups for blood loss (hemoglobin decrease, transfusion requirements, hypotension episode), incidence of wound problems (requirements for dressing reinforcement,

Regular passive ROM exercise (PROME) by a physical therapist is often incorporated in rehabilitation protocols after total knee arthroplasty (TKA). This randomized, controlled trial examined whether or not the incorporation of PROME to a postoperative rehabilitation protocol would offer a better clinical outcome after TKA. Fifty consecutive patients who underwent bilateral TKAs staged 2 weeks apart received PROME for one knee and not for the other. The pain level (7D and 14D), patient's preference (before discharge, 6M), maximum flexion (7D, 14D, 3M, 6M) and American Knee Society and WOMAC scores (6M) were determined in the knees with and without PROME and compared. There were no significant differences in the maximum flexion, pain level, patient's preference, AKS scores and WOMAC scores. This study demonstrates that the incorporation of PROME does not offer additional clinical benefits to the patients after TKA. Our findings may suggest that encouraging patients to perform active ROM exercise would be a better option and that a physiotherapy session by a physical therapist can focus on more functional rehabilitation, such as preparing to return to daily activities.

Our data suggest that antimicrobial prophylaxis using only cefazolin can maintain low SSI rates if other important infection management measures are employed, even where there is a high prevalence of MRSA infection.

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