Dynamic Observation Of Inflammatory Serological Changes After Hip And Knee Revision

Objective: The changes of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and White blood cell count(WBC)and procalcitonin(PCT)were observed before and after hip and knee arthroplasty,to study its changing characteristics and its relationship with the etiology of revision.Methods:The changes of inflammatory serological changes before and after arthroplasty in our hospital from June 2012 to June 2017 were analyzed retrospectively.A total of 33 patients with hip and knee revision were included in this study: 18 patients in the non-infective revision group,6 patients in the infected one-stage revision group,9 patients in the second-stage revision group,and 16 patients as control group.The values of CRP and ESR were recorded during 1 days,3 days,7days,10-14 days,1 month,2-3 months,4-6 months after operation.The blood routine and PCT were recorded at1 days,3 days,7 days and 10-14 days before operation and 1 days after operation.Summarize the data for statistical analysis.Results: The CRP of the four groups reached its peak on the 3rd day after operation,and then gradually decreased to normal.The level of CRP in revision group was higher than that in control group about 3 days after operation(P<0.05).After operation,the level of CRP in the non-infective revision group and the infected second-stage revision group was still higher than normal one month after operation,but the CRP in the non-infective revision group and the infected second-stage revision group had basically decreased to normal at one month after operation,and no further increase was found in the revision group from the 2-3 months to the 2-3 months after operation.There was no significant difference in CRP among the three groups(P> 0.05).The level of ESR in the four groups increased slowly and reached the peak on the 7th day after operation.The ESR in the non-infective revision group and the control group decreased basically to normal about 2-3 months after ESR operation and were followed up to the normal level in April-6 months.However,some cases of ESR were higher than normal after 2-3 months follow-up in the infected revision group.The level of ESR in the first stage revision group was higher than that in the other 3 groups(P<0.05).The level of ESR in the non-infective revision group was higher than that in the control group within 7 days after operation.There was no significant difference in ESR level between the infected group and the control group and the non-infected revision group(P>0.05).The level of WBC in the four groups did not change much and reached the peak on the first day after operation.The WBC count of the other three groups returned to normal on the 7th day except for the infected one-stage revision group and did not increase again until 10-14 days after operation.The WBC count in the infected one-stage revision group was significantly higher than that in the control group on the first day after operation(P<0.05).There was no significant difference in WBC count between the other revision group and the control group or each revision group(P>0.05).The level of PCT in the one-stage revision group began to decrease on the first day after operation,but it was still higher than that in the other three groups(P<0.05).Some patients were still above the normal value about 10-14 days after operation.The levels of PCT in the other three groups reached the peak rapidly on the first day after operation,and then decreased gradually.The control group generally decreased to the normal level on the 7th day after operation,while the non-infective revision group and the infected second-stage revision group basically decreased to the normal level on the 10-14 days after operation.Conclusion:The changes of CRP and ESR levels in patients with hip and knee revision showed a single peak curve,which was similar to the reported changes after primary arthroplasty,but the peak value was higher,and the decrease was slower and longer,especially in the patients with infected one-stage revision.The peak time of postoperative PCT is short,the specificity is high,and it is more sensitive to inflammatory reaction,so it is a better index for monitoring postoperative infection.The combined detection of CRP PCT ESR and WBC is more valuable for monitoring the infection after hip and knee revision.