Correlation Research Between Different Levels Of Preoperative ESR And CRP And Early Stage Safety After Total Joint Arthroplasty

ObjectiveInfection after total joint replacement was known as a catastrophiccomplication of total joint replacement,which was the common reason ofrevision after total joint arthroplasty.Through collecting a large number ofpreoperative ESR(erythrocyte sendimentation rate) and CRP(C-reactiveprotein) of patients who were conducted total joint arthroplasty andinformation about early postoperative infection of them,this text wastrying to investigate the relationship between different levels ofpreoperative ESR and CRP and early stage safety after total jointreplacement.Method898hips and knees for811patients being conducted total hip or totalknee replacement were collected between2012and2014in ourdepartment,meanwhile preoperative ESR and CRP and the informationabout early stage infection after the operation for each patient wererecorded.It Included402hips for362avascular necrosis of femoral head（ANFH） patients,376knees for339knee osteoarthritis(KOA)patients,120hips for110osteoarthritis secondary to developmentaldysplasia of the hip in adults.All of the898joints were classified into four groups according to the different level of preoperative ESR andCRP,including normal reference interval group,1to2times of the normalreference interval group,2to3times of the normal reference intervalgroup,and greater than3times of the normal reference intervalgroup.Statistical analysis was conducted with appropriate statisticalmethod to compare the difference between different levels of preoperativeESR and CRP and the condition of early stage infection after total jointarthroplasty.ResultThe probability and extent of rising of preoperative ESR and CRP foravascular necrosis of femoral head patients were higher than kneeosteoarthritis and developmental dysplasia of the hip in adults.There wereonly6joins in the898hips or knees which suffered early stage infectionafter the operation,and surprisingly,all of the6infected joints were fromKOA patients who were conducted TKA,besides,no infected joints waspresented in the ANFH and DDH patients who were conducted THA.There were4superficial infection and2deep infection among the6infected joints.There were no significant difference of infection rateamong the three elevated groups with preoperative ESR and CRP.Whilethe infection rate of the three elevated groups with preoperative ESR andCRP were higher than the nomal group with significant difference.(P﹤0.05) ConclutionThere is significant correlation between preoperative ESR and CRPand different type of disease,preoperative ESR and CRP should havedifferent reference baseline for different types of disease when we assessthe operation safety preliminarily.The elevated preoperative ESR andCRP could surely increase risk of early stage infection after jointreplacement，however, there is no obvious correlation between risk ofearly stage infection and preoperative ESR and CRP.Taking so manyinfluencing factors into account,we can’t use the different levels ofpreoperative ESR and CRP separately to assess safety of theoperation.For patients with elevated ESR or CRP before the operation,weshould take every influcing factors into consideration,including variety ofillness,age,gender,obesity,other medical complications, clinicalmanifestation, preoperative aspiration of the joint,and examination ofintraoperative frozen sections etc. And at last through comprehensiveevaluation we can make sure wheather the arthroplasty can be conductedor not,and its safety.