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Erythrocyte sedimentation rate and C-reactive protein values in patients with total hip arthroplasty
1Department of Orthopedics and Traumatology, VGH, Taipei, Taiwan, Republic of China.
Insights
C-reactive protein (CRP) normalization within three weeks indicates uneventful recovery after total hip arthroplasty (THA). CRP is more sensitive than erythrocyte sedimentation rate (ESR) for detecting complications and differentiating septic from mechanical loosening.
Area of Science:
- Orthopedic Surgery
- Biomarkers in Medicine
- Inflammatory Markers
Background:
- Total hip arthroplasty (THA) is a common procedure for osteoarthritis.
- Monitoring post-operative recovery and detecting complications like infection or loosening is crucial.
- Serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are commonly used inflammatory markers.
Observation:
- In uncomplicated primary THA, CRP normalized within three weeks, while ESR remained variable.
- In patients with painful hips post-THA, elevated ESR was noted in septic loosening, but CRP was significantly higher in septic cases compared to mechanical loosening.
- CRP normalized rapidly within three weeks after infection control or successful revision THA.
Findings:
- CRP normalization within three weeks reliably indicates uneventful recovery after THA, irrespective of ESR.
- CRP is a more sensitive and informative marker than ESR for differentiating septic from mechanical loosening.
- Both CRP and ESR aid in complication detection and treatment monitoring post-THA.
Implications:
- CRP serves as a valuable, sensitive biomarker for monitoring THA outcomes and diagnosing complications.
- Routine CRP monitoring can improve patient management and differentiate causes of hip pain after THA.
- This study highlights the superior utility of CRP over ESR in the early detection and differentiation of post-THA complications.
Abstract:
Serum C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were measured serially in 50 osteoarthritic patients treated with uncomplicated primary total hip arthroplasties (THAs) and also in 28 patients with painful hip for different periods after THA. The follow-up period was one year. In uncomplicated primary THA, the ESR was slightly elevated before surgery and was variable after surgery; some patients continued to have abnormally high ESRs one year after surgery. However, CRP was normal before surgery and after surgery showed a distinctive pattern that rapidly normalized within three weeks. In patients with a painful hip after THA, ESR was elevated in those with septic loosening and variable in those with mechanical loosening; however, the difference was not significant. ESR after successful revision THA was also variable. CRP was high in patients with septic loosening and normal in those with mechanical loosening. Normalization of CRP was rapid after control of infection or within three weeks of successful revision THA. Uneventful recovery after THA is indicated by normalization of CRP within three weeks, regardless of ESR. Measurement of both ESR and CRP is helpful in differentiating septic and mechanical loosening, detecting complications, and monitoring the effects of treatment, but CRP is more informative and sensitive than ESR for these purposes.