Postoperative Trends of ESR and CRP Following Total Hip Arthroplasty in the Indian Population: A Prospective...

Background Total hip arthroplasty (THA) is a widely performed orthopedic procedure used to relieve pain and restore function in patients with advanced hip disorders such as avascular necrosis and osteoarthritis. Following surgery, inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) commonly increase as part of the normal postoperative inflammatory response. However, persistent elevation may also indicate complications such as periprosthetic joint infection. Understanding the normal postoperative trends of these biomarkers is important for accurate clinical interpretation and early identification of abnormal recovery patterns. The present study aimed to characterize the postoperative temporal trends of ESR and CRP during the first 30 days following uncomplicated THA in adult Indian patients. Methods This prospective observational study was conducted in the Department of Orthopaedics at Himalayan Institute of Medical Sciences, Dehradun, over a period of 12 months. A total of 48 adult patients undergoing THA were enrolled using consecutive sampling after obtaining informed consent and ethical approval. Patients with chronic infection, inflammatory diseases, autoimmune disorders, or elevated preoperative ESR and CRP levels were excluded. ESR and CRP levels were measured preoperatively and on postoperative days (PODs) 3, 7, 14, and 30. Results The mean age of patients was 43.10 ± 10.49 years, and males constituted 70.8% of the study population. The mean preoperative ESR was 8.94 ± 6.58 mm/hr, which increased significantly to 36.02 ± 5.90 mm/hr on POD 3 and remained elevated on POD 7 before gradually declining to 28.48 ± 5.61 mm/hr on POD 30. A statistically significant variation was observed in ESR levels over time (F = 408.740, p < 0.001). The mean preoperative CRP level was 2.74 ± 1.43 mg/L. CRP showed a marked rise to 131.19 ± 30.36 mg/L on POD 3, followed by a progressive decline to 5.55 ± 3.70 mg/L by POD 30. Changes in CRP levels across postoperative intervals were also statistically significant (F = 499.360, p < 0.001). ESR demonstrated a slower normalization pattern compared to CRP, whereas CRP showed rapid postoperative elevation and faster decline toward baseline values. Conclusion ESR and CRP exhibit distinct postoperative kinetics following THA. ESR remains elevated for a longer duration, while CRP rises rapidly and declines more quickly toward baseline levels. Knowledge of these normal postoperative trends may help clinicians differentiate expected postoperative inflammatory responses from abnormal patterns suggestive of infection or other complications.