Correlation Between Preoperative Elevated ESR And CRP And Early Infection After TKA For Rheumatoid Arthritis

Objective To investigate the relationship between elevated erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)levels before total knee arthroplasty(TKA)and early postoperative infection-related complications in rheumatoid arthritis(RA)patients.Methods 119 knees for 88 patients with rheumatoid knee arthritis who underwent total knee replacement in our department between January 2014 and January 2018 were selected retrospectively.Among them,18 males and 70 females were aged(42~74),with an average age of 58.86±7.35 years,and the course of disease(1~38)years,with an average age of 15.43±9.32 years.The dynamic changes of ESR and CRP indexes measured before the surgery,the first day after the surgery,the third day after the surgery,and the last time before discharge were recorded for each patient,as well as the postoperative complications related to early infection.According to the preoperative ESR and CRP levels,they were divided into four groups: group A: ESR and CRP were less than 3 times,group B: CRP was more than 3 times and ESR was less than 3 times,group C: ESR was more than 3 times and CRP was less than 3 times,group D: ESR and CRP were both more than 3 times.SPSS19.0 software was used for statistical analysis to compare the change trend of inflammatory markers and the incidence of early postoperative infection-related complications in patients with different preoperative levels of ESR and CRP.Results The average hospitalization days of 88 patients were 10 days.In this study,group A: 20 cases(22.7%),including 7 cases of ESR and CRP in patients with normal range,group B: 16 cases(18.2%),group C: 18 cases(20.5%),group D: 34 cases(38.6%).Patients with preoperative ESR or CRP exceeding 3 times of the upper limit of the normal range accounted for the majority.The trend of postoperative ESR and CRP in the four groups was basically the same,and the last detection value was still higher than the normal range.There was no significant difference in ESR and CRP between the four groups before discharge(P > 0.05).In the group D,1 patient developed early infection 2 weeks after operation,and was treated with debridement,lavage and drainage,gasket replacement,and vancomycin,with a good prognosis.No postoperative rheumatoid activity was observed in all patients.There was no significant difference in infection rate between ESR or CRP 3 times higher than normal(group B,group C and group D)and those with ESR and CRP less than 3 times of normal value(group A)(P > 0.05).Conclusion 1.Preoperative ESR and CRP of more than half of patients with knee rheumatoid arthritis exceeded the normal range.2.ESR and CRP are indicators for the evaluation of infection and the activity of rheumatoid diseases,but their serological level alone can not indicate the activity of rheumatoid arthritis,let alone be used as strict contraindications for joint replacement surgery.3.Preoperative elevated ESR and CRP can only be used as a reference for infection,and preoperative joint puncture and intraoperative frozen section will be more helpful for perioperative evaluation.