Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011


Department of Orthopedics, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients.
Materials and Methods: This prospective study was carried out in Isfahan's educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation.
Results: Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year.
Conclusion: ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations.


Rashiq S, Finegan BA. The effect of spinal anesthesia on blood transfusion rate in total joint arthroplasty. Can J Surg 2006;49:391-6.  Back to cited text no. 1
Honsawek S, Deepaisarnsakul B, Tanavalee A, Sakdinakiattikoon M, Ngarmukos S, Preativatanyou K, et al. Relationship of serum IL-6, C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty: A prospective study. Int Orthop 2011;35:31-5.  Back to cited text no. 2
Greidanus NV, Masri BA, Garbuz DS, Wilson SD, McAlinden MG, Xu M, et al. Use of erythrocyte sedimentation rate and c-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg Am 2007;89:1409-16.  Back to cited text no. 3
Herro FA, Lozano RL, Muoz AS. Descriptive analysis of CRP after uncomplicated THA and TKA. Acta Orto Max 2008:22:80-4.  Back to cited text no. 4
Bilgen O, Atici T, Durak K, Karaeminoğullari, 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.  Back to cited text no. 5
Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res 1992;275:237-42.  Back to cited text no. 6
White J, Kelly M, Dunsmuir R. C-reactive protein level after total hip and total knee replacement. J Bone Joint Surg Br 1998;80:909-11.  Back to cited text no. 7
Park KK, Kim TK, Chang CB, Yoon SW, Park KU. Normative Temporal values of CRP and ESR in unilateral and staged bilateral TKA. Clin Orthop Relat Res 2008;466:176-88.  Back to cited text no. 8
Hashmi FR, Barlas K, Mann CF, Howell FR. Staged bilateral hip or knee arthroplasties. J Orthop Surg (Hong Kong) 2007;15:159-62.  Back to cited text no. 9
Geep B. Detection of low grade prosthetic joint Infection using TC-99-antigranulocyte SPECT/CT. Eur J Nucl Med Mol Imaging. 2010;37:1751-9.  Back to cited text no. 10
Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RS, Barrack RL. Diagnosis of infected total knee: Findings of a multicenter database. Clin Orthop Relat Res 2008;466:2628-33.  Back to cited text no. 11