| Objective:This study aimed to explore the clinical significance of preoperative erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)in knee replacement of rheumatoid arthritis(RA).Including the continuous observation of ESR and CRP changes before and after surgery,and whether the ESR or CRP higher than the normal range before replacement directly leads to an increase in the incidence of postoperative joint infection complications.This study also aimed to investigate the changes of rheumatoid disease activity and observe the postoperative efficacy after total knee arthroplasty(TKA)in RA and.Finally,we evaluated whether TKA has the ability to improve postoperative quality of life in RA patients.Methods: From January 2016 to October 2017,we followed 21 patients(28 knees)with RA treated with TKA.Preoperatively,patients with RA were routinely examined by the project of ESR,CRP,rheumatoid factor(RF),red blood cell(RBC),hemoglobin(HB),lower limb standing radiograph and knee anteroposterior and lateral radiographs.We will review the ESR and CRP indicators three consecutive times during the first week after surgery,the first month after surgery,and the third month after the surgery,and review knee anteroposterior and lateral radiographs in the third month after surgery.Knee joint function improvement and pain relief of patients with RA after TKA treatment was evaluated by comparing preoperative and postoperative third-month knee function scores(KSS),Ranges Of Motion(ROM)scores,and Visual Analogue Score(VAS)changes.In addition,the improvement of quality of life of RA patients treated with TKA was evaluated by comparing changes of the pre-operative and post-operative third-month short-term health quality questionnaire(SF-12).Results:21 patients(28 knees)with RA were followed up for 3 months after surgery.During the follow-up period,1 patient(2 knees)was found to have postoperative hypothermia,no evidence of infection in the knee joint,and was recovered by intravenous antibiotic treatment.another patient(1 knee)had poor surgical incision after surgery and was given cleaning dressing.It returned to normal one month later.Preoperatively,the average of ESR and CRP in RA patients were(39.19±28.75)mm/1h and(26.87±49.43)mg/L,respectively.It were(78.10±23.80)mm/1h and(69.39±47.33)mg/L in the first week after surgery,respectively.It was(39.71±28.33)mm/1h and(18.65±31.10)mg/L in the first month after surgery,respectively.It was(27.62±15.74)mm/1h and(10.02±7.50)mg/L in the third month after surgery,respectively.The ESR and CRP in the first postoperative week were significantly higher than before surgery,and the difference was statistically significant.However,there was no significant difference in the ESR and CRP between the first,the third postoperative month and before surgery.At the final follow-up,ROM increased from preoperative average(86.61°±20.002°)to postoperative(98.21°±9.449°).The KSS clinical score increased from an average preoperative score(33.93±17.497)to postoperative(86.75±5.648).The functional scores increased from preoperative average(31.07±25.106)to postoperative(73.21±15.882)points.VAS decreased from the preoperative average(7.89±1.548)postoperative to(1.25±1.351)points.Preoperatively,there were 17 flexor deformity knee joints in 28 cases of knee joints.The mean angle of their flexion deformities was(21.47°±9.04°),the maximum flexion deformity was 45°,and the minimum flexion deformity was 10°.Preoperatively,the mean HB of 21 RA patients was(116.4286±19.87604)g/L;the mean RBC of 21 RA patients was(4.2152±0.39996)*10^12/L.Physical Health Summary Scales(PCS)scores were increased from preoperative average(28.601±6.960)points to postoperative average(35.537±3.464)points,and mental health summary scales(MCS)scores were increased from the preoperative average(20.706±8.435)points to the postoperative average(39.553±3.784)points,and the differences were statistically significant(P<0.05).Conclusions: After TKA in RA patients,ESR and CRP levels were transiently higher than preoperative levels during the perioperative period,and were reduced to preoperative levels in the first postoperative month.TKA does not cause changes in postoperative rheumatoid disease activity in the treatment of advanced RA.Preoperative detection of ESR or CRP above the normal range will not directly lead to an increase in the incidence of postoperative joint infection complications and should not be used as a contraindication to TKA.TKA treatment of advanced rheumatoid arthritis can not only restore knee function,relieve knee pain,but also improve the physical and mental health of RA patients in the short term. |
PDF Full Text Request