Changes in pattern of Erythrocyte Sedimentation Rate and C-Reactive Protein following major elective orthopaedic surgeries

Abstract

Background and Objectives: Major surgeries are associated with various changes in the neuroendocrine and inflammatory cytokine system of the body. Most of these surgeries are performed with expensive implants and prostheses made of metals and their alloys. These metals are foreign bodies which when infected can lead to a disastrous outcome. Consequently, concerted effort is being made through the use of Erythrocyte Sedimentation Rate (ESR), C-reactive Proteins (CRP), and other acute phase proteins as a screening tool for early detection of deep surgical wound infections. The aim of this study was to determine the pattern of changes of ESR and CRP following major elective orthopaedic surgeries. Patients and Methods: This is a cross sectional study carried out over a period of six months. All patients that had major surgery within the period were noted and followed up. ESR and CRP levels were checked pre-operatively on day 0 and post-operatively on days 2, 4, 7 10, 14 and 42 using the modified Westergreen method and the High Sensitivity (HS) ELISA technique respectively. Results: The result showed a steep rise in both parameters (more than 300% constitutive levels) within 2 days post-operatively. The peak value for the mean serum CRP level was attained on day 4 post operatively with normalization to its pre-operative serum level on day 42 (P = 0.543), while the mean serum ESR reached its peak on day 7 and remained significantly higher than its pre-operative mean serum level even on day 42 post operatively (P = 0.003).Conclusion: ESR and CRP are both useful acute phase proteins for monitoring early post operative complications like surgical wound infections.