Perioperative Changes in C-Reactive Protein Levels after Unilateral and Simultaneous Bilateral Total Knee Replacement

Su-Chan Lee; Ji-Yeol Yoon; Kwang-Am Jung; Chang-Hyun Nam; Soong-Hyun Jung

doi:10.4055/jkoa.2009.44.4.442

Journal List > J Korean Orthop Assoc > v.44(4) > 1012926

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Lee, Yoon, Jung, Nam, and Jung: Perioperative Changes in C-Reactive Protein Levels after Unilateral and Simultaneous Bilateral Total Knee Replacement

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(4): 442-448.

Published online: 21 July 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.4.442

Perioperative Changes in C-Reactive Protein Levels after Unilateral and Simultaneous Bilateral Total Knee Replacement

Su-Chan Lee, M.D., Ji-Yeol Yoon, M.D.^*, Kwang-Am Jung, M.D., Chang-Hyun Nam, M.D., Soong-Hyun Jung, M.D.

Department of Orthopedic Surgery, Mok-Dong Himchan Hospital, Seoul, Korea.

^*Department of Internal Medicine, Mok-Dong Himchan Hospital, Seoul, Korea.

Correspondence to Chang-Hyun Nam, M.D. Department of Orthopedic Surgery, Mok-Dong Himchan Hospital, 404-3, Mok-dong, Yangcheon-gu, Seoul 158-806, Korea. Tel: +82.2-3219-9114, Fax: +82.2-3219-9126, changcape@naver.com

Received 24 January 2009 Accepted 5 June 2009

Abstract

Purpose

The objective of this study was to determine the patterns of C-reactive protein (CRP) changes during the postoperative period after total knee replacement (TKR), and to determine the CRP changes associated with infection after TKR.

Materials and Methods

A retrospective analysis of the pattern of CRP changes during the first 6 postoperative months was conducted on 2,315 patients who underwent unilateral or simultaneous bilateral TKR. This data was also compared with the pattern of CRP changes which occurred in 19 patients with a deep prosthesis infection who were not enrolled in the main study.

Results

The CRP levels peaked 3 days postoperatively, and then decreased to baseline levels at 15-28 days postoperatively. Within 14 days postoperatively, the CRP levels were significantly higher in the simultaneous bilateral TKA group than in the unilateral group (p<0.01). Thereafter, no significant difference in CRP levels existed between two groups. After the 8^th postoperative day, a significant difference in CRP level existed between patients with and without deep prosthesis infections.

Conclusion

CRP changes post-TKR provide an effective means of monitoring of infections. In cases of non-inflammatory arthritis in which the CRP levels are significantly difference after the 8^th postoperative day or are elevated after the 4^th postoperative week, an infection should be suspected.

Keywords: Total knee replacement, C-reactive protein, Prosthesis joint infection

Figures and Tables

Fig. 1

The change of average CRP levels in each perioperative interval in unilateral TKR (UTKR) group and simultaneous bilateral TKR (BTKR) group. Within 14 days postoperatively, CRP levels were significantly higher in the simultaneous bilateral TKA Group than in the unilateral group (p<0.01).

Fig. 2

The comparison of the change of average CRP levels in whole study cases and deep prosthesis joint infection (PJI) cases. After 8 days postoperatively, a significant difference was observed between patients with and without deep prosthesis infection.

Fig. 3

ROC curve (receiver operating characteristic curve) for CRP values in postoperative 8 to 14 days shows fair discrimination (Area under the curve=0.699) in unilateral TKR group and simultaneous bilateral TKR group.

Table 1

Patient Demographics

^*BTKR, bilateral total knee replacement; ^†UTKR, unilateral total knee replacement.

Table 2

Sample Numbers of CRP Values in each Interval

^*Preop., preoperative period; ^†POD, postoperative day.

Table 3

Comparison of Perioperative C-reactive Protein Levels in each Subgroup of Unilateral TKR and Simultaneous Bilateral TKR

CRP, values were extracted as a maximum value of selected interval of each case; BTKR, bilateral total knee replacement; UTKR, unilateral total knee replacement; ^*p<0.01; ^†Two-sample Kolmogorov-Smirnov test between all infection and non infection cases.

Table 4

ROC (Receiver Operating Characteristic) Curve of CRP Values in Each Postoperative Period

^*Preop., preoperative period; ^†POD, postoperative day.

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