Skip to main content

Advertisement

Log in

Normative Temporal Values of CRP and ESR in Unilateral and Staged Bilateral TKA

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research

Abstract

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.

Level of Evidence: Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2A–B

Similar content being viewed by others

References

  1. Aalto K, Osterman K, Peltola H, Räsänen J. Changes in erythrocyte sedimentation rate and C-reactive protein after total hip arthroplasty. Clin Orthop Relat Res. 1984;184:118–120.

    PubMed  Google Scholar 

  2. Bilgen O, Atici T, Durak K, Karaeminogullari O, Bilgen MS. C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res. 2001;29:7–12.

    PubMed  CAS  Google Scholar 

  3. Böttiger LE, Svedberg CA. Normal erythrocyte sedimentation rate and age. Br Med J. 1967;2:85–87.

    Article  PubMed  Google Scholar 

  4. Carlsson AS. Erythrocyte sedimentation rate in infected and non-infected total-hip arthroplasties. Acta Orthop Scand. 1978;49:287–290.

    Article  PubMed  CAS  Google Scholar 

  5. Choudhry RR, Rice RP, Triffitt PD, Harper WM, Gregg PJ. Plasma viscosity and C-reactive protein after total hip and knee arthroplasty. J Bone Joint Surg Br. 1992;74:523–524.

    PubMed  CAS  Google Scholar 

  6. Cottone S, Nardi E, Mulè G, Vadala A, Lorito MC, Riccobene R, Palermo A, Arsena R, Guarneri M, Cerasola G. Association between biomarkers of inflammation and left ventricular hypertrophy in moderate chronic kidney disease. Clin Nephrol. 2007;67:209–216.

    PubMed  CAS  Google Scholar 

  7. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340:448–454.

    Article  PubMed  CAS  Google Scholar 

  8. Kolstad K, Levander H. Inflammatory laboratory tests after joint replacement surgery. Ups J Med Sci. 1995;100:243–248.

    Article  PubMed  CAS  Google Scholar 

  9. Kushner I, Gewurz H, Benson MD. C-reactive protein and the acute-phase response. J Lab Clin Med. 1981;97:739–749.

    PubMed  CAS  Google Scholar 

  10. Laiho K, Mäenpää H, Kautiainen H, Kauppi M, Kaarela K, Lehto M, Belt E. Rise in serum C reactive protein after hip and knee arthroplasties in patients with rheumatoid arthritis. Ann Rheum Dis. 2001;60:275–277.

    Article  PubMed  CAS  Google Scholar 

  11. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.

    Article  PubMed  CAS  Google Scholar 

  12. Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res. 1992;275:237–242.

    PubMed  Google Scholar 

  13. Laskin RS. The patient with a painful total knee replacement. In: Lotke PA, Garino JP, eds. Revision Total Knee Arthroplasty. Philadelphia, PA: Lippincott-Raven Publishers; 1999:91–106.

    Google Scholar 

  14. Levitsky KA, Hozack WJ, Balderston RA, Rothman RH, Gluckman SJ, Maslack MM, Booth RE Jr. Evaluation of the painful prosthetic joint: relative value of bone scan, sedimentation rate, and joint aspiration. J Arthroplasty. 1991;6:237–244.

    Article  PubMed  CAS  Google Scholar 

  15. Liu TK, Chen SH. Simultaneous bilateral total knee arthroplasty in a single procedure. Int Orthop. 1998;22:390–393.

    Article  PubMed  CAS  Google Scholar 

  16. Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement—a safer approach in older patients. Knee. 2001;8:207–211.

    Article  PubMed  CAS  Google Scholar 

  17. McLaughlin TP, Fisher RL. Bilateral total knee arthroplasties: comparison of simultaneous (two-team), sequential, and staged knee replacements. Clin Orthop Relat Res. 1985;199:220–225.

    PubMed  Google Scholar 

  18. Mehta SK, Rame JE, Khera A, Murphy SA, Canham RM, Peshock RM, de Lemos JA, Drazner MH. Left ventricular hypertrophy, subclinical atherosclerosis, and inflammation. Hypertension. 2007;49:1385–1391.

    Article  PubMed  CAS  Google Scholar 

  19. Mont MA, Waldman B, Banerjee C, Pacheco IH, Hungerford DS. Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplasty. 1997;12:426–433.

    Article  PubMed  CAS  Google Scholar 

  20. Moreschini O, Greggi G, Giordano MC, Nocente M, Margheritini F. Postoperative physiopathological analysis of inflammatory parameters in patients undergoing hip or knee arthroplasty. Int J Tissue React. 2001;23:151–154.

    PubMed  CAS  Google Scholar 

  21. Mulvey TJ, Thornhill TS. Infected total knee arthroplasty. In: Insall JN, Scott WN, eds. Surgery of the Knee. Philadelphia, PA: Churchill Livingstone; 2001:1875–1890.

    Google Scholar 

  22. Niskanen RO, Korkala O, Pammo H. Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg Br. 1996;78:431–433.

    PubMed  CAS  Google Scholar 

  23. Okafor B, MacLellan G. Postoperative changes of erythrocyte sedimentation rate, plasma viscosity and C-reactive protein levels after hip surgery. Acta Orthop Belg. 1998;64:52–56.

    PubMed  CAS  Google Scholar 

  24. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA. 2001;286:327–334.

    Article  PubMed  CAS  Google Scholar 

  25. Rosas MH, Leclercq S, Pégoix M, Darlas Y, Aubriot JH, Rousselot P, Marcelli C. Contribution of laboratory tests, scintigraphy, and histology to the diagnosis of lower limb joint replacement infection. Rev Rhum Engl Ed. 1998;65:477–482.

    PubMed  CAS  Google Scholar 

  26. Sanzen L, Carlsson AS. The diagnostic value of C-reactive protein in infected total hip arthroplasties. J Bone Joint Surg Br. 1989;71:638–641.

    PubMed  CAS  Google Scholar 

  27. Shih LY, Wu JJ, Yang DJ. Erythrocyte sedimentation rate and C-reactive protein values in patients with total hip arthroplasty. Clin Orthop Relat Res. 1987;225:238–246.

    PubMed  Google Scholar 

  28. Swanson KC, Windsor RE. Diagnosis of infection after total knee arthroplasty. In: Callaghan JJ, Rosenberg AG, Rubash HE, Simonian PT, Wickiewicz TL, eds. The Adult Knee. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:1485–1491.

    Google Scholar 

  29. Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. Philadelphia, PA: Saunders Elsevier; 2007:465–468.

    Google Scholar 

  30. Virolainen P, Lahteenmaki H, Hiltunen A, Sipola E, Meurman O, Nelimarkka O. The reliability of diagnosis of infection during revision arthroplasties. Scand J Surg. 2002;91:178–181.

    PubMed  CAS  Google Scholar 

  31. Wasielewski RC, Barden RM, Rosenberg AG. Results of different surgical procedures on total knee arthroplasty infections. J Arthroplasty. 1996;11:931–938.

    Article  PubMed  CAS  Google Scholar 

  32. White J, Kelly M, Dunsmuir R. C-reactive protein level after total hip and total knee replacement. J Bone Joint Surg Br. 1998;80:909–911.

    Article  PubMed  CAS  Google Scholar 

  33. Widmer AF. New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis. 2001;33(suppl 2):S94–S106.

    Article  PubMed  Google Scholar 

  34. Yoon SI, Lim SS, Rha JD, Kim YH, Kang JS, Baek GH, Yang KH. The C-reactive protein (CRP) in patients with long bone fractures and after arthroplasty. Int Orthop. 1993;17:198–201.

    Article  PubMed  CAS  Google Scholar 

  35. Zauber NP, Zauber AG. Hematologic data of healthy very old people. JAMA. 1987;257:2181–2184.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Sung Ju Kim, MPH, Korea Center for Disease Control for help with statistical analyses, Yeon Gwi Kang, Kwang Sook Shin, and Ji Won Moon for data collection and patient interviews in this study, and Dr. Edward G. McFarland of the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, for helpful conversations and critical review of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tae Kyun Kim MD, PhD.

Additional information

One or more of the authors (KTK) have received funding from the clinical research fund (060429) of Seoul National University Bundang Hospital.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

About this article

Cite this article

Park, K.K., Kim, T.K., Chang, C.B. et al. Normative Temporal Values of CRP and ESR in Unilateral and Staged Bilateral TKA. Clin Orthop Relat Res 466, 179–188 (2008). https://doi.org/10.1007/s11999-007-0001-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-007-0001-x

Keywords

Navigation