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

Abstract

Introduction: To evaluate the trends of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) in the first three weeks after uncomplicated total hip (THR) and total knee (TKR) arthroplasty/replacement in the Indian population and to compare it with available literature. Materials and methods: A total of 90 patients were enrolled for this prospective study, of which 30 were unilateral THR, 30 were unilateral TKR (U/L TKR) and 30 were simultaneous bilateral TKR (B/L TKR). Serum CRP and ESR were measured on the day before surgery and post-operatively on day 1st, 2nd, 3rd, 7th, 12th, and at the end of 3rd week. Results: CRP showed a peak at day 2nd with normalisation to pre-operative value by the end of 3rd week. While ESR showed a peak on day 3rd and continued to remain elevated even at end of 3rd week post-operatively. Both mean CRP and ESR values were higher in THR patients followed by in B/L TKR and then in U/L TKR patients. Conclusion: CRP persists to be the best acute phase reactant in the early post-operative phase with a relatively typical pattern as compared to ESR. CRP values peak at post-operative day 2nd and then show a gradual decline. However, its normalisation to pre-operative baseline values may vary among different groups of population.

Oral enzyme combination with bromelain, trypsin and the flavonoid rutoside reduces systemic inflammation and pain when used pre- and post-operatively in elective total hip replacement: a randomized exploratory placebo-controlled trial

“…45 After uncomplicated THR, the CRP levels in one study involving 30 patients was reported to reach a mean value of 204.88 mg/L at day 2. 42 In our study, the CRP levels also exhibited an early postoperative peak (at day 3), but at a slightly lower level (mean 81.4 mg/L in the OEC group and mean 106.7 mg/L in the placebo group) than in the mentioned study. Nevertheless, in the OEC group, CRP levels were reduced by 32% relative to the placebo group over the 7-day observation period, indicating a reduction in trauma-induced inflammation with the OEC.…”

“…CRP typically reaches a peak on the second or third post-operative day following hip or knee arthroplasties, [42][43][44] and reflects the extent of…”

“…CRP typically reaches a peak on the second or third post-operative day following hip or knee arthroplasties, 42 – 44 and reflects the extent of surgical trauma, as well as type of tissue injured. 43 In a study of THR after femoral neck fracture, CRP levels notably increased in the first post-operative week after surgery, and gradually normalized in the following weeks.…”

Association between traditional Chinese Medicine and osteoarthritis outcome: A 5-year matched cohort study

“…Inflammatory reactions play an indispensable role in the pathogenesis of OA, which produces pain, swelling, and joint incompetence [ 36 ]. CRP [ 37 ] and ESR [ 38 ] increase during inflammatory responses and are commonly used as initial preliminary diagnoses as well as follow-up tools to monitor response to treatment because they are inexpensive, noninvasive, and widely available tests. Activation of the innate immune system is closely related to the initiation and persistence of inflammation [ 39 ], mediating OA pathology and pain at multiple levels.…”