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Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty
Sebastian Rohe1, Eric Röhner1, Christoph Windisch2
1Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany.
Insights
Men show higher C-reactive protein (CRP) levels after total hip arthroplasty (THA) compared to women in the first week post-surgery. This gender difference in CRP response is significant in complication-free cases.
Area of Science:
- Orthopedics
- Inflammation Markers
- Gender-Specific Medicine
Background:
- C-reactive protein (CRP) is a key inflammatory marker used after total hip arthroplasty (THA).
- Previous research shows controversy regarding sex-specific differences in postoperative CRP levels.
- Understanding these differences is crucial for accurate patient monitoring.
Purpose of the Study:
- To investigate the influence of sex on CRP levels in the first 10 days after uncomplicated THA.
- To re-evaluate the typical postoperative CRP profile, including its peak.
- To determine if gender impacts CRP trends in a complication-free recovery.
Main Methods:
- Retrospective review of 1,255 patients undergoing THA for primary osteoarthritis (2013-2016).
- Exclusion of patients with inflammatory conditions, active cancer, or postoperative complications.
- Analysis of CRP values pre- and up to 10 days post-THA, with adjustments for confounders like age, BMI, and operation time.
Main Results:
- Men had higher CRP values than women from postoperative day 2 to day 7.
- The most significant CRP difference was observed on day 4 (men: 130.48 mg/L vs. women: 87.26 mg/L, p=0.018).
- Men were younger with longer operation times and higher BMI, but key comorbidities showed no sex difference.
Conclusions:
- A significant gender discrepancy in CRP levels exists after uncomplicated THA within the first 7 postoperative days.
- This study provides precise, sex-specific data on the postoperative CRP course.
- The typical CRP peak on the third postoperative day was confirmed.
Background:
Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days.
Methods:
We retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]).
Results:
A total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m2), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; p = 0.018).
Conclusions:
Based on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.
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