Londhe Sanjay Bhalchandra, Shah Ravi Vinod, Doshi Amit Pankaj, Londhe Shubhankar Sanjay, Subhedar Kavita
Criticare Hospital, Plot No 516, Besides SBI, Telli Galli, Andheri East, Mumbai, Maharashtra, 400069, India.
Hinduja Healthcare, Mumbai, India.
Arthroplasty. 2020 Aug 27;2(1):24. doi: 10.1186/s42836-020-00043-7.
This study was to determine how C-reactive protein (CRP) responds after total knee replacement (TKR), including both unilateral and simultaneous bilateral TKR in Indian population and if it follows Anglo-Saxon trend. Published literature from North America and Europe shows CRP value peaks on the 2nd post-operative day and drops to normal by 6-8 weeks. We started the study with null hypothesis.
This is a prospective study, with 50 patients (all females, 25 received unilateral operations and 25 bilateral ones) included. CRP levels were measured, on the 2nd day, 8, 12 and 16 weeks after operation.
In both groups, CRP level rose the 2nd post-operative day. The rise in CRP level was significantly higher in the simultaneous bilateral TKR group than in the unilateral TKR group. In unilateral cases, CRP on the 2nd postoperative day ranged from 65 to 110 mg/l with average level of 80 mg/ml. In bilateral TKR cases, CRP level on the 2nd postoperative day was between 110 and 180 mg/l with a mean of 140 mg/ml. The CRP level returned to normal in about 40% of unilateral TKR patients 8 weeks after operation, while in 92% (23 out of 25) of bilateral simultaneous TKR patients it stayed at a high level 8 weeks post-op and did not come back to normal. At 12 weeks CRP decreased to normal in all 100% of unilateral TKR patients and 32% of bilateral TKR patients. At 16 weeks, CRP was normal in all bilateral TKR patients.
60% of our unilateral TKR patients and 92% of our simultaneous bilateral TKR patients did not achieve a normal CRP 8 weeks after operation. These findings are significant as CRP is commonly used as a very sensitive indicator of postoperative joint infection. Hence we conclude that in the Indian TKR patients the CRP values take longer time to return to normal than in their Anglo-Saxon counterparts. Published results regarding the normal levels of CRP in unilateral TKR should not be extrapolated to simultaneous bilateral TKR patients.
本研究旨在确定印度人群全膝关节置换术（TKR）后，包括单侧和同期双侧TKR，C反应蛋白（CRP）的反应情况，以及其是否遵循盎格鲁-撒克逊人的趋势。来自北美和欧洲的已发表文献表明，CRP值在术后第2天达到峰值，并在6-8周降至正常水平。我们以零假设开始本研究。
这是一项前瞻性研究，纳入50例患者（均为女性，25例行单侧手术，25例行双侧手术）。在术后第2天、8周、12周和16周测量CRP水平。
两组患者术后第2天CRP水平均升高。同期双侧TKR组CRP水平的升高显著高于单侧TKR组。单侧病例术后第2天CRP范围为65至110mg/l，平均水平为80mg/ml。双侧TKR病例术后第2天CRP水平在110至180mg/l之间，平均为140mg/ml。约40%的单侧TKR患者术后第8周CRP水平恢复正常，而92%（25例中的23例）的双侧同期TKR患者术后第8周仍处于高水平，未恢复正常。术后第12周，100%的单侧TKR患者和32%的双侧TKR患者CRP降至正常。术后第16周，所有双侧TKR患者CRP均恢复正常。
我们的单侧TKR患者中有60%以及同期双侧TKR患者中有92%在术后8周CRP未恢复正常。这些发现具有重要意义，因为CRP通常被用作术后关节感染的非常敏感的指标。因此，我们得出结论，印度TKR患者CRP值恢复正常所需的时间比盎格鲁-撒克逊人对应人群更长。关于单侧TKR中CRP正常水平的已发表结果不应外推至同期双侧TKR患者。
