Abstract
Purpose
Laboratory diagnostics are part of the routine before and after operations. In all specialist surgical disciplines, including orthopaedic surgery, the acute-phase protein CRP is used to detect inflammatory processes, especially infections. The potential influence of patient gender on the postoperative course of CRP after TKA implantation is still unclear. In order to achieve a more precise evaluation of the complication-free general CRP course after TKA, the objective of the present study is to test the hypothesis that the p.o. course and level of CRP is gender specific in the first 10 days after TKA.
Methods
A total of 1068 consecutive patients who had been treated with a unilateral primary cemented total knee replacement due to primary osteoarthritis of the knee over a 36-month period were retrospectively included in the study. For all patients, the preoperative CRP value and the postoperative course of CRP from postoperative days 1–10 were recorded and tested for gender specificity.
Results
On days 2–5 and 7–8 after surgery, men had significantly higher CRP values than women. The maximum difference was 45 mg/L on the fourth p.o. day (men 170 mg/L, women 125 mg/L, p = 0.019).
Conclusion
The present study was able to show, for the first time, that the complication-free course of CRP in the first 10 days after TKA implantation is gender specific. The impact of the finding on diagnostic is that the gender-specific CRP course provides a more precise evaluation of the complication-free course of CRP after TKA. These results have clinical relevance to the interpretation of postoperative CRP values in order to avoid unnecessary investigations such as puncture or surgical care in female and male patients with uncomplicated TKA.
Level of evidence Diagnostic study, III.
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References
Bagry H, de la Cuadra Fontaine JC, Asenjo JF, Bracco D, Carli F (2008) Effect of a continuous peripheral nerve block on the inflammatory response in knee arthroplasty. Reg Anesth Pain Med 33(1):17–23
Egsgaard LL, Eskehave TN, Bay-Jensen AC, Hoeck HC, Arendt-Nielsen L (2015) Identifying specific profiles in patients with different degrees of painful knee osteoarthritis based on serological biochemical and mechanistic pain biomarkers: a diagnostic approach based on cluster analysis. Pain 156(1):96–107
Ellitsgaard N, Andersson AP, Jensen KV, Jorgensen M (1991) Changes in C-reactive protein and erythrocyte sedimentation rate after hip fractures. Int Orthop 15(4):311–314
Elsenberg EH, van Werkum JW, van de Wal RM, Zomer AC, Bouman HJ, Verheugt FW, Berg JM, Hackeng CM (2009) The influence of clinical characteristics, laboratory and inflammatory markers on ‘high on-treatment platelet reactivity’ as measured with different platelet function tests. Thromb Haemost 102(4):719–727
Fehring TK, Odum SM, Hughes J, Springer BD, Beaver WB Jr (2009) Differences between the sexes in the anatomy of the anterior condyle of the knee. J Bone Joint Surg Am 91(10):2335–2341
Glehr M, Friesenbichler J, Hofmann G, Bernhardt GA, Zacherl M, Avian A, Windhager R, Leithner A (2013) Novel biomarkers to detect infection in revision hip and knee arthroplasties. Clin Orthop Relat Res 471(8):2621–2628
Honsawek S, Deepaisarnsakul B, Tanavalee A, Sakdinakiattikoon M, Ngarmukos S, Preativatanyou K, Bumrungpanichthaworn P (2011) Relationship of serum IL-6, C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty: a prospective study. Int Orthop 35(1):31–35
Larsson S, Thelander U, Friberg S (1992) C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res 275:237–242
Lear SA, Chen MM, Birmingham CL, Frohlich JJ (2003) The relationship between simple anthropometric indices and C-reactive protein: ethnic and gender differences. Metabolism 52(12):1542–1546
Li K, Langdale E, Tashman S, Harner C, Zhang X (2012) Gender and condylar differences in distal femur morphometry clarified by automated computer analyses. J Orthop Res 30(5):686–692
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(4):151–154
Neumaier M, Braun KF, Sandmann G, Siebenlist S (2015) C-reactive protein in orthopaedic surgery. Acta Chir Orthop Traumatol Cechoslov 82(5):327–331
Neumaier M, Metak G, Scherer MA (2006) C-reactive protein as a parameter of surgical trauma: CRP response after different types of surgery in 349 hip fractures. Acta Orthop 77(5):788–790
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(1):179–188
Pepys MB (1981) C-reactive protein fifty years on. Lancet 1(8221):653–657
Pichardo JC, Trindade AA, Brindle JM, Bolch WE (2007) Method for estimating skeletal spongiosa volume and active marrow mass in the adult male and adult female. J Nucl Med 48(11):1880–1888
Rondanelli M, Klersy C, Perna S, Faliva MA, Montorfano G, Roderi P, Colombo I, Corsetto PA, Fioravanti M, Solerte SB, Rizzo AM (2015) Effects of two-months balanced diet in metabolically healthy obesity: lipid correlations with gender and BMI-related differences. Lipids Health Dis 14:139
Scherer MA, Neumaier M, von Gumppenberg S (2001) C-reactive protein in patients who had operative fracture treatment. Clin Orthop Relat Res 393:287–293
Shen H, Zhang N, Zhang X, Ji W (2009) C-reactive protein levels after 4 types of arthroplasty. Acta Orthop 80(3):330–333
Thienpont E, Grosu I, Jonckheere S, Yombi JC (2013) C-reactive protein (CRP) in different types of minimally invasive knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(11):2603–2610
Watt DG, Horgan PG, McMillan DC (2015) Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery 157(2):362–380
White J, Kelly M, Dunsmuir R (1998) C-reactive protein level after total hip and total knee replacement. J Bone Joint Surg Br 80(5):909–911
Yombi JC, Schwab PE, Thienpont E (2015) Serum C-reactive protein distribution in minimally invasive total knee arthroplasty do not differ with distribution in conventional total knee arthroplasty. PLoS One 10(4):e0124788
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An erratum to this article is available at http://dx.doi.org/10.1007/s00167-017-4457-2.
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Windisch, C., Brodt, S., Roehner, E. et al. The C-reactive protein level after total knee arthroplasty is gender specific. Knee Surg Sports Traumatol Arthrosc 24, 3163–3167 (2016). https://doi.org/10.1007/s00167-016-4289-5
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DOI: https://doi.org/10.1007/s00167-016-4289-5