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Presl J, Ehgartner M, Schabl L, Singhartinger F, Gantschnigg A, Wallner E, Jäger T, Emmanuel K, Kessler H, Koch OO. Robotic surgery versus conventional laparoscopy in sigmoid colectomy for diverticular disease-a comparison of operative trauma and cost-effectiveness: retrospective, single-center analysis. Langenbecks Arch Surg 2024; 409:200. [PMID: 38935194 PMCID: PMC11211106 DOI: 10.1007/s00423-024-03382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Robotic assisted surgery is an alternative, fast evolving technique for performing colorectal surgery. The primary aim of this single center analysis is to compare elective laparoscopic and robotic sigmoid colectomies for diverticular disease on the extent of operative trauma and the costs. METHODS Retrospective analysis from our prospective clinical database to identify all consecutive patients aged ≥ 18 years who underwent elective minimally invasive left sided colectomy for diverticular disease from January 2016 until December 2020 at our tertiary referral institution. RESULTS In total, 83 patients (31 female and 52 male) with sigmoid diverticulitis underwent elective minimally invasive sigmoid colectomy, of which 42 underwent conventional laparoscopic surgery (LS) and 41 robotic assisted surgery (RS). The mean C-reactive protein difference between the preoperative and postoperative value was significantly lower in the robotic assisted group (4,03 mg/dL) than in the laparoscopic group (7.32 mg/dL) (p = 0.030). Similarly, the robotic´s hemoglobin difference was significantly lower (p = 0.039). The first postoperative bowel movement in the LS group occurred after a mean of 2.19 days, later than after a mean of 1.63 days in the RS group (p = 0.011). An overview of overall charge revealed significantly lower total costs per operation and postoperative hospital stay for the robotic approach, 6058 € vs. 6142 € (p = 0,014) not including the acquisition and maintenance costs for both systems. CONCLUSION Robotic colon resection for diverticular disease is cost-effective and delivers reduced intraoperative trauma with significantly lower postoperative C-reactive protein and hemoglobin drift compared to conventional laparoscopy.
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Affiliation(s)
- Jaroslav Presl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - M Ehgartner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - L Schabl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - F Singhartinger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - A Gantschnigg
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - E Wallner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - T Jäger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - H Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - O O Koch
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
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Rohe S, Böhle S, Matziolis G, Layher F, Brodt S. Elastic Compression Dressing after Total Hip Replacement Slightly Reduces Leg Swelling: A Randomized Controlled Trial. J Clin Med 2024; 13:2207. [PMID: 38673482 PMCID: PMC11050482 DOI: 10.3390/jcm13082207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Even minor adverse reactions after total hip replacement (THR), including lymphedema, postoperative leg swelling, and blood loss, compromise patient comfort in times of minimally invasive fast-track surgery. Compression dressings are commonly used in surgical practice to reduce swelling or blood loss. However, the use of spica hip compression dressings after primary THR is controversial, and prospective studies are lacking. Methods: We conducted a prospective, single-center, two-arm, randomized controlled trial (RCT) of patients undergoing THR for primary osteoarthritis. A total of 324 patients were enrolled; 18 patients were excluded, and 306 patients were finally analyzed. Leg swelling as primary endpoint was measured pre- and postoperatively with a rotating 3D infrared body scanner. Secondary endpoints were transfusion rate and blood loss, estimated by Nadler and Gross formulas. Results: Postoperative leg swelling was lower in the compression group (241 ± 234 mL vs. 307 ± 287 mL; p = 0.01), even after adjustment for surgery time and Body-Mass-Index (BMI) (p = 0.04). Estimated blood loss was also lower in the compression group on the first (428 ± 188 mL vs. 462 ± 178 mL; p = 0.05) and third (556 ± 247 mL vs. 607 ± 251 mL; p = 0.04) postoperative days and leveled off on the fifth postoperative day, but lost significance after adjustment for BMI and surgery time. Neither group received a transfusion. Conclusions: Compression dressing after THR in the context of minimally invasive surgery slightly reduces leg swelling, but has no effect on blood loss or blood transfusion rate. So, this method could not generally be recommended in primary hip replacement.
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Affiliation(s)
- Sebastian Rohe
- Orthopedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (S.B.); (G.M.); (F.L.); (S.B.)
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Sereda AP, Rukina AN, Trusova YV, Dzhavadov AA, Cherny AA, Bozhkova SA, Shubnyakov II, Tikhilov RM. Dynamics of C-reactive protein level after orthopedic surgeries. J Orthop 2024; 47:1-7. [PMID: 38046451 PMCID: PMC10689206 DOI: 10.1016/j.jor.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Only two studies present the results of the dynamics of C-reactive protein (CRP) after a large number of orthopedic surgeries. The aim of the study was to investigate the dynamics of CRP levels and determine the influence of various factors on the CRP level after various orthopedic surgeries using big data tools. Methods A total of 16042 operated patients were included in the study. Results The tendency of peak values to increase by 2-3 days after surgery with subsequent decrease was the same in all subgroups without surgical site infections (SSI). In patients with SSI, the higher preoperative CRP level changed to a peak on day 3 after surgery with a subsequent drop and increase after day 6 in case of probably unsuccessful sanitation. The peak value of CRP significantly correlates with the duration of surgery (r = 0.1072, p < 0,0001). Older patients tend to exhibit higher CRP value (r = 0.2219, p < 0.001). The peak values of CRP in women were significantly greater than those in men. Conclusion In cases without SSI, the peak of CRP values occurs on the second or third day after surgery, a secondary increase in CRP levels may indicate a risk of complications. The peak CRP value correlates with the duration of surgery. In clinical practice, relationship between gender, age and the level of CRP should not be one of the indicators influencing the assessment of the risk of a threat to the patient's health, since the results of various studies are contradictory.
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Affiliation(s)
- Andrei P. Sereda
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
- Department of the Academy of Postgraduate Education of Federal Medical Biological Agency, Moscow, Russian Federation
| | - Anna N. Rukina
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Yulia V. Trusova
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Alisagib A. Dzhavadov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Alexander A. Cherny
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Svetlana A. Bozhkova
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Igor I. Shubnyakov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Rashid M. Tikhilov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
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Ziaei Darounkolaei N, Mousavi Kiasary SMS, Behzadi A, Nabavi Mosavi N, Ferdowsi SM. Instrument shank-assisted ovariohysterectomy: a randomized clinical trial of surgical and pain alleviation efficiency of a single-person modified technique. Front Vet Sci 2023; 10:1210089. [PMID: 37915948 PMCID: PMC10616265 DOI: 10.3389/fvets.2023.1210089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Objectives To evaluate a modified ovariohysterectomy (OHE) technique performed by a single person and compare it with the conventional method based on time efficiency, trauma, and postoperative pain. Methods In a prospective, randomized, experimental study, 18 healthy, large, deep-chested, mixed-breed intact female dogs were randomly allocated to conventional (n = 9) and instrument shank-assisted (n = 9) groups. On the basis of video recordings, the various surgical step durations were analyzed: total surgery time (TST), pedicle intervention time (PIT), suspensory release time (SRT), shanking time (ShT), clamping time (ClpT), ligating time (LigT), and closure time (CT). The Glasgow composite pain scale short-form (GCMPS-SF), university of Melbourne pain scale (UMPS), and Visual Analogue Scales (VAS) were used to measure pain. C-reactive protein (CRP) fluctuation was also investigated. These evaluations were completed before and 6, 24, 48, and 72 h postoperatively. Results Instrument shank-assisted OHE was less time-consuming than conventional OHE (p = 0.005), improved PIT by 30.7% (6.44 min for both pedicles, p = 0.014), and correlated strongly with TST (ρ = 0.862, p = 0.003 and ρ = 0.955, p = 0.000, respectively). The two method's surgical step durations were also TST = 47.40 ± 9.9 vs. 34.70 ± 6.7 min, PIT = 20.96 ± 5.78 vs. 14.52 ± 3.73 min, SRT = 78.97 ± 69.10 vs. ShT = 20.39 ± 8.18 s (p = 0.035), ClpT = 50.66 ± 45.04 vs. 63.55 ± 37.15 s (p = 0.662), LigT = 12.82 ± 3.37 vs. 8.02 ± 3.11 min (p = 0.005), and CT = 16.40 ± 4.5 vs. 11.60 ± 2.5 min (p = 0.013), respectively. While both techniques inflicted pain on the animals, the novel approach resulted in a reduction of pain at T6 (GCMPS-SF, p = 0.015 and VAS, p = 0.002), T24 (UMPS, p = 0.003), and T48 (GCMPS-SF, p = 0.015 and UMPS, p = 0.050). Both methods exhibited a peak in CRP level after 24 h, which subsequently returned to baseline after 48 h. However, the shank-assisted method demonstrated a significantly lower reduction in CRP level at the 48-h compared to the other group (p = 0.032). Conclusion Instrument shank-assisted technique permitted ovarian removal without an assistant, less damage to animals and reducing its time when compared to a conventional technique, and resulting in an alternative that causes less surgical stress and fatigue. Further research with a larger population size is required to determine the serum CRP levels as an alternative pain biomarker.
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Affiliation(s)
- Navid Ziaei Darounkolaei
- Babol Branch, Department of Surgery and Radiology, Faculty of Veterinary Medicine, Islamic Azad University, Babol, Iran
| | - Seyed Mohamad Sadegh Mousavi Kiasary
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Amirhoushang Behzadi
- Babol Branch, Faculty of Veterinary Medicine, Islamic Azad University, Babol, Iran
| | - Niki Nabavi Mosavi
- Babol Branch, Department of Surgery and Radiology, Faculty of Veterinary Medicine, Islamic Azad University, Babol, Iran
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Bum Kwon J, Woo Bae J, Jin Bae D, Eun Jeong J, Choi WK. The degree of C-reactive protein elevation after total knee arthroplasty is related to bone and medullary injury rather than soft tissue. Medicine (Baltimore) 2023; 102:e35472. [PMID: 37832115 PMCID: PMC10578698 DOI: 10.1097/md.0000000000035472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
First, we want to find out whether computer-assisted surgery (CAS) for total knee arthroplasty (TKA), which does not require opening the femoral medullary canal, results in a lesser C-reactive protein (CRP) level increase postoperatively compared to manual TKA. Second, they seek to examine whether the CRP reduction in CAS TKA and manual TKA follows a similar pattern within the first 2 weeks after surgery. Third, the study aims to compare and analyze the CRP levels in 3 different groups: CRP levels in CAS TKA with surgeons who started TKA surgery by CAS, CRP levels in manual TKA by surgeons with little experience, and CRP levels in skillful manual TKA performed after conducting over 200 cases. The 3 patient groups were as follows. Group 1: Patients who underwent non expertized surgeon CAS TKA (N = 63). Group 2: Patients who underwent manual TKA after surgeon CAS TKA experience (N = 108). Group 3: Patients who underwent manual TKA after surgeon 200 cases or more of either CAS TKA or manual TKA experience (more skillful manual TKA) (N = 66). CRP levels were analyzed using electronic medical records for 3 time points: within 3 months before surgery, 5 days after surgery, and 11 days after surgery. There were no statistically significant differences in pre operative CRP values among the 3 groups. At 5 days after surgery, the CRP level were 48.59 ± 32.75 for CAS TKA, 69.82 ± 42.76 for early manual TKA, and 67.73 ± 44.00 for skillful manual TKA, indicating a statistically significant lower CRP level in the CAS TKA group compared to the manual TKA groups (P = .01). At 11 days after surgery, there were no statistically significant differences in CRP level among the 3 groups, with was 12.12 ± 9.74 for CAS TKA, 14.07 ± 13.18 for early manual TKA, and 11.43 ± 11.45 for skillful manual TKA. The degree of CRP elevation after TKA is related to bone and medullary injury rather than soft tissue.
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Affiliation(s)
- Jae Bum Kwon
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Jin Woo Bae
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Dong Jin Bae
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Ji Eun Jeong
- Departhment of Pediatrics, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Won-Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
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Michalska M, Grochowiecki T, Wyczałkowska-Tomasik A, Pączek L, Jakimowicz T, Cacko A, Jama K, Stec A, Sikorska E, Nazarewski S, Gałązka Z. Evaluation of selected parameters of inflammation, coagulation system, and formation of extracellular neutrophil traps (NETs) in the perioperative period in patients undergoing endovascular treatment of thoracoabdominal aneurysm with a branched device (t-Branch). Front Cardiovasc Med 2023; 10:1153130. [PMID: 37745097 PMCID: PMC10513084 DOI: 10.3389/fcvm.2023.1153130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Extracellular Neutrophils Traps (NETs) and their formation, known as NETosis, have become pivotal in the pathogenesis of aortic aneurysm development. This study investigates the NETosis markers with the assessment of selected parameters of inflammation and coagulation system in patients with thoracoabdominal aortic aneurysms in the pre-and postop period undergoing t-Branch stent-graft implantation. The study included 20 patients with thoracoabdominal aortic aneurysms. Three markers double-stranded DNA (dsDNA), single-stranded DNA (ssDNA), and citrullinated H3 histones (Cit-H3) were tested at three-time points from patients' blood. The parameters of NETosis, inflammation, and coagulation system were examined in the preoperative period (within 24 h before surgery) and in the postoperative period (on the 3rd and 5th postoperative day). Free-circulating DNA (cfDNA) was isolated from the blood using the MagMAXTM Cell-Free DNA Extraction Kit. Double-stranded DNA (dsDNA) and single-stranded DNA (ssDNA) were then quantified using the Qubit dsDNA HS Assay Kit and the Qubit ssDNA Assay Kit. Cit-H3 concentration was determined by enzyme immunoassay ELISA (Cayman). The results revealed the significance of NETs secretion in response to the complex processes after stent-graft implantation. All NET markers increased shortly after surgery, with histones being the first to return to preoperative levels. The lack of normalization of dsDNA and ssDNA levels to preoperative levels by the last postoperative blood collection demonstrates NETs reorganization. The increase in the number of neutrophils was not related to the expansion of postoperative NETosis. The study reveals a new marker of NETosis, ssDNA, that has not been studied so far. The implantation of a stent graft in a patient with TAAA triggers an inflammatory response manifested by an increase in inflammatory parameters. One of the hallmarks of inflammation is the activation of neutrophil extracellular traps.
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Affiliation(s)
- Milena Michalska
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Tadeusz Grochowiecki
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Leszek Pączek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Jakimowicz
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Cacko
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Jama
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Albert Stec
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Sikorska
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Sławomir Nazarewski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gałązka
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
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Kang MS, Park HJ, You KH, Choi DJ, Park CW, Chung HJ. Comparison of Primary Versus Revision Lumbar Discectomy Using a Biportal Endoscopic Technique. Global Spine J 2023; 13:1918-1925. [PMID: 35176889 PMCID: PMC10556890 DOI: 10.1177/21925682211068088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To compare the clinical outcomes of the biportal endoscopic technique for primary lumbar discectomy (BE-LD) and revision lumbar discectomy (BE-RLD). METHODS Eighty-one consecutive patients who underwent BE-LD or BE-RLD, and could be followed up for at least 12 months were divided into two groups: Group A (BE-LD; n = 59) and Group B (BE-RLD; n = 22). Clinical outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab's criteria. Perioperative results included operation time (OT), length of hospital stay (LOS), amount of surgical drain, and kinetics of serum creatine phosphokinase (CPK) and C-reactive protein (CRP). Clinical and perioperative outcomes were assessed preoperatively and postoperatively at 2 days and at 3, 6, and 12 months. Postoperative complications were noted. RESULTS Both groups showed significant improvement in pain (VAS) and disability (ODI) compared to baseline values at postoperative day 2, which lasted until the final follow-up. There were no significant differences in the improvement of the VAS and ODI scores between the groups. According to the modified MacNab's criteria, 88.1 and 90.9% of the patients were excellent or good in groups A and B, respectively. OT, LOS, amount of surgical drain, and kinetics in serum CRP and CPK levels were comparable. Complications in Group A included incidental durotomy (n = 2), epidural hematoma (n = 1), and local recurrence (n = 1) and in Group B incidental durotomy (n = 1) and epidural hematoma (n = 1). CONCLUSION BE-RLD showed favorable clinical outcomes, less postoperative pain, and early laboratory recovery equivalent to BE-LD.
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Affiliation(s)
- Min-Seok Kang
- Department of Orthopedic Surgery,
Spine Center, Bumin Hospital Seoul, Seoul, Korea
| | - Hyun-Jin Park
- Department of Orthopedic Surgery,
Spine Center, Kangnam Sacred Heart
Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ki-Han You
- Department of Orthopedic Surgery,
Spine Center, Kangnam Sacred Heart
Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae-Jung Choi
- Department of Orthopedic Surgery, Himnaera Hospital, Busan, Korea
| | - Chang-Won Park
- Department of Orthopedic Surgery,
Spine Center, Kangnam Sacred Heart
Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hoon-Jae Chung
- Department of Orthopedic Surgery,
Spine Center, Bumin Hospital Seoul, Seoul, Korea
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De Berardinis L, Senarighi M, Farinelli L, Qordja F, Gallo A, Spezia M, Gigante AP. In primary total hip arthroplasty, the direct anterior approach leads to higher levels of creatine kinase and lower levels of C-reactive protein compared to the posterolateral approach: a propensity score matching analysis of short-term follow-up data. J Orthop Surg Res 2023; 18:594. [PMID: 37568175 PMCID: PMC10416395 DOI: 10.1186/s13018-023-04084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This retrospective study compares the invasiveness of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA) by assessing three widely used inflammation-related serum markers in the first ten post-operative days. METHODS The database of our institution was mined for primary THAs conducted by the DAA or the PLA from February 2020 to June 2022. Demographics and creatine kinase (CK), C-reactive protein (CRP), and white blood cells were compared. Propensity Score Matching (PSM) analysis (1:1 ratio) was conducted based on multiple variables. RESULTS PSM analysis yielded 44 pairs of DAA and PLA patients. CK was significantly higher (p < 0.001) in the DAA than in the PLA group on postoperative day (POD) 2, 5 and 10. The POD2, POD5 and POD10 CK/preoperative CK ratio was 12.9, 5.0 and 0.8 in DAA and 8.8, 3.3 and 0.6 in PLA (p = 0.017, p = 0.012 and p = 0.025, respectively). The POD2, POD5 and POD10 CRP/preoperative CRP ratio was 95.1, 65.6 and 22.8 in PLA and 34.7, 23.3 and 8.9 in DAA (p < 0.001, p = 0.002 and p < 0.001, respectively). CONCLUSION PSM analysis of early postoperative CK and CRP values demonstrated that the DAA should be considered as a less stressful approach, not as a muscle-sparing or a minimally invasive THA approach.
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Affiliation(s)
- Luca De Berardinis
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy.
| | - Marco Senarighi
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Luca Farinelli
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Fjorela Qordja
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Alberto Gallo
- Orthopedic Unit, Habilita Casa di Cura I Cedri, Via Don Guanella, 1, 28073, Fara Novarese, NO, Italy
| | - Marco Spezia
- Orthopedic Unit, Habilita Casa di Cura I Cedri, Via Don Guanella, 1, 28073, Fara Novarese, NO, Italy
| | - Antonio Pompilio Gigante
- Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
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Altinayak H, Karatekin YS, Balta O. The relationship of C-reaktif protein level after knee artroplasty with gender difference and type of artroplasty. J Orthop Surg (Hong Kong) 2023; 31:10225536231190309. [PMID: 37501564 DOI: 10.1177/10225536231190309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
PURPOSE It was aimed to reveal the relationship between CRP level after knee arthroplasty and gender difference and arthroplasty type. METHODS Preoperative and postoperative (1st and 7th day, 1st and 3rd months) CRP values of the patients who underwent TKA or UKA were examined. The data were compared by categorizing them into primary male-female, secondary TKA-UKA groups. RESULTS 967 patients were included in the study (151 male, 685 female in the TKA group and 25 male, 106 female in the UKA group) In the TKA group, the mean age was 67.38 in males and 65.54 in females. In the UKA group, the mean age was 58.72 in males and 57,63 in females. CRP values were found to be statistically significantly lower in females compared to males in the preoperative period, postoperative 1st and 3rd months in patients who underwent TKA (p < .05). In the UKA group, it was found to be significantly lower in females in the preoperative period and at the postoperative 3rd month, p < .05). When the CRP values and their effect on the course of arthroplasty were evaluated according to the type of arthroplasty, there was no significant difference between the CRP values of the preoperative patients (p = .686). In addition, in the comparison made on the postoperative 1st day, 1st week, 1st month, and 3rd month, CRP values of the patient who underwent UKA were found to be significantly lower (p < .05). When analyzed separately by arthroplasty type, postoperative CRP values decreased to normal limits in 96.3% of patients who underwent TKA and 98.5% of patients who underwent UKA in the third month. CONCLUSIONS Our study showed that the uncomplicated course of CRP after TKA and UKA is gender-specific, and higher CRP values are observed in males than in females. The UKA group exhibited significantly lower postoperative CRP levels than the TKA group.
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Affiliation(s)
- Harun Altinayak
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, Ilkadim, Turkey
| | - Yavuz Selim Karatekin
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, Ilkadim, Turkey
| | - Orhan Balta
- Department of Orthopaedics and Traumatology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Huang X, Wang W, Chen G, Guan X, Zhou Y, Tang Y. Comparison of surgical invasiveness, hidden blood loss, and clinical outcome between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:274. [PMID: 37038129 PMCID: PMC10088165 DOI: 10.1186/s12891-023-06374-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Currently, hidden blood loss (HBL) has been paid more and more attention by spine surgeons. Simultaneously, it has been the effort of spine surgeons to explore more advantages of minimally invasive surgery. More and more articles have compared unilateral biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). But so far, there is no HBL comparison between BE-LIF and MIS-TLIF. This study aims to compare the surgical invasiveness, hidden blood loss, and clinical outcome of BE-LIF and MIS-TLIF and to provide insight regarding minimally invasive surgery for lumbar degenerative disease (LDD). METHODS We enrolled 103 eligible patients with LDD who underwent BE-LIF (n = 46) and MIS-TLIF (n = 57) during August 2020-March 2021. We collected data, including demographics, perioperative haematocrit, operative and postoperative hospital times, serum creatine kinase (CK) and C-reactive protein (CRP) levels, and hospitalization costs. Total and hidden blood loss was calculated. Clinical outcomes were assessed using a visual analogue scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and complications. RESULTS Basic demographics and surgical data were comparable. The CRP and CK levels were generally lower in the BE-LIF than in the MIS-TLIF group, especially CRP levels on postoperative day (POD) three and CK levels on POD one. True total blood loss, postoperative blood loss, and hidden blood loss were significantly reduced in the BE-LIF group compared with the MIS-TLIF group. Postoperative hospital times was statistically significantly shorter in the BE-LIF group. The VAS pain and ODI scores improved in both groups. At three days and one month, the VAS lower back pain scores were significantly better after BE-LIF. Clinical outcomes did not otherwise differ between groups. CONCLUSIONS Compared with MIS-TLIF, BE-LIF has similar medium and short-term clinical outcomes. However, it is better regarding surgical trauma, early lower back pain, total and hidden blood loss, and recovery time. BE-LIF is an adequate option for selected LDD.
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Affiliation(s)
- Xinle Huang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Wenkai Wang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Guangxing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xiangchen Guan
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China.
| | - Yu Tang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China.
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Carvajal JL, Kim SE. Serum acute-phase protein concentrations following uncomplicated total hip arthroplasty in dogs. Vet Surg 2023; 52:81-86. [PMID: 36148894 DOI: 10.1111/vsu.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/13/2022] [Accepted: 08/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To establish preoperative and postoperative serum C reactive protein (CRP) and serum amyloid A (SAA) levels in dogs undergoing uncomplicated total hip arthroplasty (THA). STUDY DESIGN Prospective clinical trial. ANIMALS Eighteen client-owned dogs. METHODS Dogs undergoing THA were recruited. Serum CRP and SAA levels were measured in all dogs the day prior to surgery, and 3 and 6 months following surgery. All dogs received a physical examination and underwent radiography at each visit, and dogs with complications were excluded from the study. For continuous numeric data, histograms were generated and evaluated for normality. A 1-way repeated measures ANOVA was performed to find differences between time points. RESULTS No complications were encountered in any of the recruited dogs. Median age was 30 months (12-66), and the median bodyweight was 27.3 kg (22.3-40.2). Mean CRP concentrations in the preoperative, 3-month, and 6-month periods were 3.8 mg/L ± 4.4, 0.8 mg/L ± 1.9, and 1.4 mg/L ± 1.4, respectively. The mean SAA concentrations in the preoperative, 3-month, and 6-month periods were 13.9 mg/L ± 8.8, 14.1 mg/L ± 12.6, and 18.4 mg/L ± 15.1, respectively. There were no differences for each parameter between time points. CONCLUSION C-reactive protein and SAA levels were consistent with levels previously established for noninflammatory and normal conditions in dogs. CLINICAL SIGNIFICANCE Postoperative CRP and SAA concentrations were low by 3 months following uncomplicated THA.
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Affiliation(s)
- Jose L Carvajal
- Department of Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Stanley E Kim
- Department of Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Aoki Y, Suzuki M, Takahashi H, Nakajima A, Sonobe M, Kotani T, Nakajima T, Sato Y, Inoue M, Saito J, Norimoto M, Eguchi Y, Orita S, Ohtori S, Nakagawa K. Comparison of pain and discomfort in supine and lateral positions after surgery for lumbar degenerative disease: A prospective randomized controlled study. Int J Orthop Trauma Nurs 2022; 47:100959. [PMID: 36055074 DOI: 10.1016/j.ijotn.2022.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To compare postoperative pain and discomfort between supine and lateral positions after lumbar surgery, a prospective randomized controlled study was performed. METHODS Forty-three patients with lumbar degenerative disease, treated by decompression (n = 23) or fusion surgery (n = 20), were randomly assigned to be placed in either the supine (supine group: n = 21) or lateral (lateral group: n = 22) position postoperatively, and asked to maintain their position until a day after the surgery. Postoperative back pain and discomfort (visual analog scale [VAS], 0-100 mm) and the number of patients who could maintain their position were examined. RESULTS The VAS scores for back pain (supine: 64.9 ± 22.0, lateral: 55.7 ± 21.4) showed no significant difference between the positions. However, the supine group showed significantly more severe discomfort (75.6 ± 15.7) than the lateral group (64.9 ± 15.7, p = 0.039). Significantly fewer patients maintained their position in the supine group (28.2%) than in the lateral group (68.2%; p = 0.022). Among patients who underwent fusion surgery, significantly fewer patients maintained their position in the supine group (10.0%) than those in the lateral group (60.0%, p = 0.029). CONCLUSION Postoperative discomfort was significantly reduced in the lateral position than in the supine position; thus, the lateral position is more suitable after lumbar surgery in terms of postoperative discomfort.
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Affiliation(s)
- Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.
| | - Makoto Suzuki
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
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Maezawa K, Nozawa M, Gomi M, Sugimoto M, Maruyama Y. Changes in serum creatine kinase and C-reactive protein after posterior and direct anterior approaches in total hip arthroplasty. Hip Int 2022; 32:591-595. [PMID: 33290100 DOI: 10.1177/1120700020978643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Some studies reported that measuring serum creatine kinase (CK) level is an objective method with which to determine the relative invasiveness of surgery. The purpose of this study was to evaluate the change in postoperative serum CK levels as a measure of whether the direct anterior approach (DAA) is less invasive than the posterior approach (PA) regarding postoperative rehabilitation. MATERIALS AND METHODS We prospectively recruited 71 women who were undergoing total hip arthroplasty, 47 were treated by the PA and 24 by the DAA. Serum CK and C-reactive protein (CRP) levels were measured preoperatively and 3 hours and 1, 4, 7, 10, and 14 days after the operation. RESULTS The serum CK levels were significantly higher in the DAA group than in the PA group on postoperative days 1, 4, 7, 10, and 14. On postoperative day 4 and 7, the percentage of patients whose serum CK levels were above the normal range was 46.8% and 8.5% in the PA group and 95.2% and 45.5% in the DAA group. CONCLUSIONS CK levels were significantly higher in the 2 weeks after THA by a DAA than after the same procedure by a PA indicating that DAA causes prolonged muscle damage. Although the DAA is considered to be a muscle-sparing approach this may not be the case and DAA may not actually be a minimally-invasive approach.
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Affiliation(s)
- Katsuhiko Maezawa
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Masahiko Nozawa
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Motoshi Gomi
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Munehiko Sugimoto
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Yuichiro Maruyama
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
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14
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C-reactive protein and its ratio are useful indicators to exclude anastomotic leakage requiring intervention after laparoscopic rectal surgery. Updates Surg 2022; 74:1637-1643. [DOI: 10.1007/s13304-022-01358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022]
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Naung Tun H, Kyaw MT, Rafflenbeul E, López Suástegui X. Role of Direct Oral Anticoagulants for Post-operative Venous Thromboembolism Prophylaxis. Eur Cardiol 2022; 17:e11. [PMID: 35620356 PMCID: PMC9127635 DOI: 10.15420/ecr.2021.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/28/2022] [Indexed: 11/19/2022] Open
Abstract
Venous thromboembolism (VTE) is one of the leading causes of post-operative morbidity and mortality. Over previous decades, heparin and warfarin were the predominant therapeutic options for post-operative thromboprophylaxis. However, their use is limited by drawbacks including a narrow therapeutic range, numerous food and drug interactions, and the need for regular monitoring for dose adjustments. Recently, direct oral anticoagulants (DOACs), such as dabigatran etexilate (a direct thrombin inhibitor) and apixaban, rivaroxaban and edoxaban (direct factor Xa inhibitors), have been developed to overcome these issues. DOACs have shown promising results in Phase III clinical trials for post-operative VTE prophylaxis. This review summarises the pharmacological profile of DOACs and highlights the use of DOACs in post-operative VTE prophylaxis based on the available clinical trial data.
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Affiliation(s)
- Han Naung Tun
- Larner College of Medicine, University of Vermont, Burlington, VT, US
| | - May Thu Kyaw
- Heart and Vascular Centre, Victoria Hospital, Yangon, Myanmar
| | - Erik Rafflenbeul
- Department of Cardiology, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
| | - Xiuhtlaulli López Suástegui
- Emergency Department, Intensive Care Unit Hospital Regional de Alta Especialidad de Zumpango, Instituto Mexicano del Seguro Social, Zumpango de Ocampo, Mexico
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Choi YS, Oh JB, Chang MJ, Kim TW, Kang KS, Kang SB. Delayed normalization of C-Reactive protein and erythrocyte sedimentation rate was not associated with inferior clinical outcomes after total knee arthroplasty. J Orthop Sci 2022; 28:589-596. [PMID: 35331605 DOI: 10.1016/j.jos.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/06/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study aimed to identify the proportion of patients with delayed normalization of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) after TKA, to determine postoperative thresholds predictive of prolonged elevation. Further, we aimed to determine if the clinical outcomes of patients with prolonged elevation were inferior to those without prolonged elevation. METHODS The records of 211 unilateral and 320 bilateral TKA were reviewed. Patients were divided into the normal and elevation group based on CRP and ESR levels at 6 weeks and 3 months. The temporal pattern of CRP and ESR change in both groups was compared, and thresholds predictive of elevation at 6 weeks and 3 months were identified. Further, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and Tegner activity scale of both groups at 6 months, 1 year, and 2 years after TKA were compared. RESULTS The proportion of patients with elevated CRP and ESR at 6 weeks and 3 months was CRP: 24.2%, 10%, ESR: 51.6%, 29.9% in unilateral and CRP: 31.5%, 10.6%, ESR: 58.1%, 42.7% in bilateral TKA. The thresholds for elevation at 6 weeks and 3 months were 9.5 mg/dL, 11.4 mg/dL (CRP at 6 weeks) and 81.5 mm/h, 74.5 mm/h (ESR at 3 months). There was no difference in the WOMAC score and Tegner activity scale between both groups. CONCLUSIONS CRP and ESR are often elevated for a prolonged period even in the absence of infection after TKA. Such cases show distinct temporal patterns, which are predictable, and do not appear to have a significant effect on clinical outcome.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.
| | - Jong Byung Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
| | - Kee Soo Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
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Shetty S, Ethiraj P, Shanthappa AH. C-reactive Protein Is a Diagnostic Tool for Postoperative Infection in Orthopaedics. Cureus 2022; 14:e22270. [PMID: 35350520 PMCID: PMC8931842 DOI: 10.7759/cureus.22270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
Background Orthopedic fracture-associated infection is a prevalent complication with a huge burden on the healthcare infrastructure. C-reactive protein (CRP) is a widely used serum inflammatory marker in patients with infections in orthopaedics. It could be difficult to distinguish between CRP elevation caused by surgical site infection and CRP elevation caused by surgery and trauma in orthopaedic procedures. In most situations, a clinical diagnosis of post-surgical infection is sufficient, however, the use of a biomarker with predictive value for acute post-op complications could prompt an earlier diagnosis. This study, therefore, aims at assessing CRP levels in post-operative orthopaedic trauma patients and determining the reliability of CRP as an early indicator of postoperative infection. Materials and methods A prospective study was conducted between December 2020 and November 2021 in the department of orthopaedics in Sri Devaraj Urs medical college, Kolar. Patients with an open and closed fracture of the upper and lower extremities treated by osteosynthesis on an elective or emergency basis were included. The clinical parameters were studied on the day of trauma, postoperative days first, third and seventh. Blood samples for CRP were taken prior to the surgical procedure and on the same days as clinical monitoring. The CRP levels were compared between patients with postoperative infection and patients without postoperative infections using independent samples t-test. A p-value of < 0.05 was considered statistically significant. Results A total of 51 patients were included in the study meeting the inclusion criteria, of which mean standard deviation for age was 37.5 (15.7%), 44 were men (86.2%) and seven were women (13.7%), Patients according to Tscherene classification grade I were 10 (19.6%), grade II were eight (15.6%), grade III were 15 (29.4%) and grade IV was 18 (35.2%), type of fracture surgery diaphyseal were 27 (52.9%), proximal was 11 (21.5%) and distal were 13 (25.4%). 15 patients developed postoperative infection with CRP levels of 96 µg/mL in nine (17.6%), 48 µg/mL in four (7.8%) and 24 µg/mL in two (3.9%). Thirty-six patients who did not develop post-operative infection had CRP levels of 6 µg/mL in 31 (60.8%) and 12 µg/mL in five (9.8%). The p-value for the first postoperative day was 0.289 and statistically insignificant and on the third and seventh postoperative days was <0.001 and was found to be statistically significant. Conclusion C-reactive protein is a useful parameter to detect and monitor post-operative infections in orthopaedic trauma surgeries. The rise in C-reactive protein on the third and seventh postoperative days can be used as a reliable predictor of post-operative infections.
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Kopechek KJ, Cvetanovich GL, Everhart JS, Frantz TL, Samade R, Bishop JY, Neviaser AS. Factors Associated With Elevated Inflammatory Markers Prior to Shoulder Arthroplasty. HSS J 2022; 18:70-77. [PMID: 35087335 PMCID: PMC8753553 DOI: 10.1177/1556331621998662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
Background: Preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) ranges for several shoulder arthroplasty indications are not well understood. Purpose: We sought to compare preoperative ESR and CRP values for a variety of shoulder arthroplasty indications and evaluate risk factors for elevated preoperative ESR and CRP values. Methods: We conducted a retrospective cohort study of shoulder arthroplasty cases performed at a single academic medical institution from 2013 to 2018. Preoperative ESR and CRP values for 235 shoulder arthroplasties with various indications were recorded. Independent risk factors for elevated values (CRP > 10.0 mg/L and ESR > 30.0 mm/h) were determined via multiple variable logistic regression. Results: Patients undergoing shoulder arthroplasty for osteoarthritis had an ESR (mean ± SD) of 22.6 ± 17.8, with 29.8% of patients elevated, and a CRP of 6.5 ± 6.4, with 25.5% of patients elevated. Arthroplasty for acute fracture and prosthetic joint infection (PJI) had higher preoperative ESR and CRP values. Multivariate analysis identified several predictors of elevated ESR, including infection, acute fracture, diabetes, and female sex. It also identified predictors of elevated CRP, including infection, acute fracture, and younger age. Conclusions: Preoperative ESR and CRP values may be elevated in 25% to 30% of patients undergoing primary shoulder arthroplasty. Arthroplasty for both acute fracture and PJI, along with several other patient factors, was associated with elevated preoperative ESR and CRP. Thus, routine collection of ESR and CRP preoperatively may not be of benefit, as elevated values are common. Further study is warranted.
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Affiliation(s)
- Kyle J. Kopechek
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gregory L. Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joshua S. Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Travis L. Frantz
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Y. Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrew S. Neviaser
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA,Andrew S. Neviaser, MD, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Rohe S, Röhner E, Windisch C, Matziolis G, Brodt S, Böhle S. Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty. Clin Orthop Surg 2022; 14:48-55. [PMID: 35251541 PMCID: PMC8858890 DOI: 10.4055/cios21110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days. Methods We retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]). Results A total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m2), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; p = 0.018). Conclusions Based on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | | | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
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Hughes JL, Allen BC, Shaver C. Role of inflammatory markers in the preoperative evaluation of patients undergoing salvage total hip arthroplasty. Proc AMIA Symp 2022; 35:10-14. [PMID: 34970024 DOI: 10.1080/08998280.2021.1977077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Surgeons may use laboratory tests, including erythrocyte sedimentation rate, C-reactive protein (CRP), and white blood cell count, as well as joint aspirations to diagnose prosthetic joint infections. There is a paucity of literature correlating preoperative inflammatory markers with risk of infection in the setting of salvage total hip arthroplasty (THA). This retrospective case analysis included patients who underwent a THA salvage procedure a minimum of 3 months after a failed fixation of a proximal femur or acetabulum, with a goal of assessing the utility of inflammatory markers as a screening tool in preoperative evaluation of salvage THA. Eighty-five patients met inclusion criteria. Thirteen patients were diagnosed with an infection preoperatively or intraoperatively during salvage THA. An elevated preoperative CRP level was a significant marker for infection. A CRP of 7.1 produced 80% sensitivity, 88% specificity, and a receiver operating characteristic curve of 0.840. There was a high rate of perioperative complications (17.6%) in salvage THA regardless of the presence of infection. In conclusion, CRP levels are useful in the preoperative evaluation for periprosthetic joint infection before salvage THA.
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Affiliation(s)
- Jessica L Hughes
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Bryce C Allen
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Courtney Shaver
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center - Temple, Temple, Texas
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21
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Nurcahyo WI, Arifin A, Primatika AD, Muttaqin Z, Elfira Boom C, Harahap MS, Mochamat M, Nugroho TE, Wicaksono SA. An Association Between C-Reactive Protein Levels and the Occurrence of Cognitive Dysfunction After Heart Valve Replacement. Vasc Health Risk Manag 2021; 17:713-720. [PMID: 34824534 PMCID: PMC8610747 DOI: 10.2147/vhrm.s334982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) is defined as cognitive dysfunction related to inflammation after surgical procedures, which is common following cardiac surgery. Cognitive deficits are thought to result from a systemic inflammatory response. C-reactive protein (CRP) and other proinflammatory cytokines, which are released in response to inflammation, disrupt the blood–brain barrier and neurotransmission, resulting in POCD. This study aimed to determine the correlation between POCD and increased levels of CRP in patients who had undergone heart valve replacement. Methods This study comprised 32 patients with normal cognitive function undergoing heart valve replacement. The CRP levels were measured before surgery and on the second postoperative day, and cognitive function was examined via the Indonesian-adapted Montreal Cognitive Assessment (MOCA-INA) on the third postoperative day. Data were analyzed using Spearman correlation test. Results Of the 32 patients, 28 (87.5%) experienced POCD. The median level of CRP was 6.6 mg/dL (interquartile range: 4.0, 8.3 g/dL). According to Spearman correlation test, increased levels of CRP were significantly related to POCD following heart valve replacement (p = 0.003, r = 0.501). The receiver operating characteristic curve indicated that the CRP cutoff level was 3.345 mg/dL, and the sensitivity and specificity were 89.3% and 75%, respectively. Conclusion High expression level of CRP was correlated with POCD following heart valve replacement.
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Affiliation(s)
- Widya Istanto Nurcahyo
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Anshoril Arifin
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Aria Dian Primatika
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Cindy Elfira Boom
- Department of Anesthesiology and Intensive Care, Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | - M Sofyan Harahap
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Mochamat Mochamat
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Taufik Eko Nugroho
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
| | - Satrio Adi Wicaksono
- Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia
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Cho MR, Choi WK, Jun CM, Song SK. The natural trends of C-reactive protein after hip arthroplasty for femoral neck fracture without infection. Medicine (Baltimore) 2021; 100:e27299. [PMID: 34559143 PMCID: PMC8462584 DOI: 10.1097/md.0000000000027299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to estimate the degree of normalization of C-reactive protein (CRP) at 2-weeks and 4-weeks after hip arthroplasty after femoral neck fracture. We also wished to determine whether the degree of CRP normalization differs after total hip arthroplasty (THA) compared to bipolar hemiarthroplasty (BH). We also wanted to analyze the patient factors that may influence CRP normalization.We conducted a retrospective study of 135 patients who had undergone THA (32 cases) or BH (103 cases) for femoral neck fracture by single surgeon from January 2015 to December 2019. We analyzed CRP levels during the preoperative period, the early postoperative period, the 2-week postoperative period, and the 4-week postoperative period.In THA, CRP was normalized in 4 patients (12.5%) and in 15 patients (46.9%) within 2-weeks and 4-weeks after surgery, respectively. In BH, CRP was normalized in 16 patients (15.5%) and in 52 patients (50.5%) within 2-weeks and 4-weeks after surgery, respectively. There were no statistical differences between THA and BH. Compared to women, men were 3.78 (95% confidence interval, 1.05-13.63) times less likely to have normalized CRP at 2-weeks after surgery (P = .042). Compared to women, men were 3.01 (95% confidence interval, 1.44-6.27) times less likely to have normalized CRP at 4-weeks after surgery (P = .003).Only 50% of patient's CRP level was normalized during 4-week postoperative period. In men, CRP levels were significantly higher than women in whole period. In the case of THA, the CRP level was higher only in early postoperative period compared to BH, and there was no difference since then.
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Rohe S, Brodt S, Windisch C, Matziolis G, Böhle S. [Patient safety during endoprosthetic training : Does the training of surgeons in primary hip arthroplasty at certified endoprosthesis centres lead to increased complications?]. DER ORTHOPADE 2021; 51:52-60. [PMID: 33929552 PMCID: PMC8766393 DOI: 10.1007/s00132-021-04110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Ziel der Studie war die Untersuchung, ob sich das perioperative Outcome und operationsspezifische Prozessgrößen bei Patienten mit Hüftgelenksersatz signifikant verschlechtern, wenn die Operation durch einen unerfahrenen Operateur, assistiert durch einen erfahrenen Operateur, im Kontext eines zertifizierten Endoprothesenzentrums durchgeführt wird. Material und Methoden Es wurden 1480 Patienten eingeschlossen, die zwischen 2013 und 2016 bei primärer Koxarthrose mit einer primären zementfreien Hüfttotalendoprothese (HTEP) versorgt wurden. Die relevanten Daten wurden retrospektiv aus dem Krankenhausinformationssystem, dem Entlassungsbrief und aus dem EndoCert-Bogen dokumentiert. Die Operateure wurden nach ihrer Qualifikation in erfahrene (Senior, > 50 HTEP pro Jahr) und unerfahrene Operateure (Junior, < 50 HTEP pro Jahr) unterteilt. Anschließend erfolgte der Vergleich der erhobenen Daten anhand dieser Unterteilung. Resultate Es zeigte sich bei unerfahrenen Operateuren eine signifikante Verlängerung der Operationsdauer um 20,7 min (Senior 62,6 ± 20,4 min; Junior 83,3 ± 19,5 min; p ≤ 0,001), der Krankenhausverweildauer um 0,25 Tage (Senior 8,8 ± 0,9 d; Junior 9,0 ± 0,9 d; p ≤ 0,001) und eine Erhöhung der Transfusionshäufigkeit von Erythrozytenkonzentraten (Senior 0,6 ± 1,1 Stk.; Junior 0,9 ± 1,4 Stk.; p ≤ 0,001). Dagegen zeigte sich kein Unterschied bei perioperativen Komplikationen (p = 0,682) und beim perioperativen Blutverlust (Senior 1,3 ± 0,5 l; Junior 1,3 ± 0,5 l; p = 0,097). Zwischen Operationsdauer und Blutverlust bestand allerdings eine positive Korrelation (Senior r = 0,183; Junior r = 0,214; jeweils p ≤ 0,01). Schlussfolgerung Die Ausbildung von unerfahrenen Operateuren an einem zertifizierten Endoprothesenzentrum führt bei Assistenz durch erfahrene Operateure nicht zur Reduktion der Patientensicherheit mit vermehrten Komplikationen. Aufgrund der Operationszeitverlängerung kommt es allerdings zu einer Mehrbelastung der Kliniken im Wettbewerb mit nichtausbildenden Kliniken, die nicht im DRG-System abgebildet ist.
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Affiliation(s)
- S Rohe
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland.
| | - S Brodt
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
| | - C Windisch
- Abteilung für Orthopädie und Unfallchirurgie, Helios Klinikum Blankenhain, Wirthstr. 5, 99444, Blankenhain, Deutschland
| | - G Matziolis
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
| | - S Böhle
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
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Aggarwal A, Sinha V, Chan E, Parapuram A. An elevated C-reactive protein level in an inpatient rehabilitation setting after joint replacement: To act or not to act? - that is the question. Medicine (Baltimore) 2021; 100:e24584. [PMID: 33663068 PMCID: PMC7909121 DOI: 10.1097/md.0000000000024584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
C-reactive protein (CRP) is part of a battery of "routine bloods" performed by residents on patients when they are admitted into a rehabilitation unit. Generally, an elevated CRP is considered to be an indicator of an acute infective process. Numerous studies have indicated that the CRP peaks on the 2nd or 3rd day post total hip arthroplasty (THR) and total knee arthroplasty (TKR) and returns to normal by day 7. When the CRP level remains elevated, it is generally felt that infection should be excluded.We performed a prospective study on 45 consecutive patients admitted into a rehabilitation unit post hip and knee arthroplasty over a 6 months period, to evaluate the incidence of an elevated CRP on admission, to determine whether an isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process.We found all patients (100%) had elevated CRP's on admission, ranging from 8.6 mg/L to 139.2 mg/L, between days 5-7 post-operatively. By day 14, CRP's reduced, but 91% of patients still had elevated CRP's, ranging from 2.1 mg/L to 47.3 mg/L after THR and 4.8 mg/L to 40 mg/L after TKR at day 14.These results suggest that even in uncomplicated elective joint arthroplasty, CRP's can remain elevated up to 14 days post-procedure, in the absence of an infective process.An isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process, but rather part of the normal post-operative inflammatory response. The elevated CRP should be monitored and only an upward trend requires further investigation and management.
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Affiliation(s)
- Arun Aggarwal
- Neurologist and Rehabilitation / Pain Physician, Metropolitan Rehabilitation Hospital & Hunters Hill Private Hospital
| | - Vikram Sinha
- Rehabilitation Medicine Registrar, Metropolitan Rehabilitation Hospital
| | - Eric Chan
- General Practice Registrar, Hunters Hill Private Hospital
| | - Anuka Parapuram
- Rehabilitation Medicine Physician, Metropolitan Rehabilitation Hospital, Sydney, NSW, Australia
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Xiong Z, Cao S, Zhou L, Zhang X, Liu Q, Hu J, Liu F, Li Y. Intraoperative periarticular injection can alleviate the inflammatory response and enhance joint function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures. Medicine (Baltimore) 2021; 100:e24596. [PMID: 33607792 PMCID: PMC7899865 DOI: 10.1097/md.0000000000024596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study aimed to investigate the potential beneficial effects of periarticular injection (PAI) of multimodal drugs on the inflammatory response and joint function after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures. METHODS Fifty six elderly patients with unilateral osteoporotic femoral neck fractures were randomly allocated to 2 groups: the PAI group, which received the multimodal drug PAI intraoperatively before incision closure, and the control group, which received an injection of saline at the same time as placebo. The C-reactive protein (CRP), interleukin-1β (IL-1β), and IL-6 levels as well as the erythrocyte sedimentation rate (ESR) in peripheral venous blood samples were measured, along with the Visual Analogue Scale (VAS) score with activity and Harris hip score preoperation at 1, 2, 4, 7, and 14 days as well as 1 and 3 months post-operation. RESULTS The 2 groups were comparable in sex and age, and no significant differences were observed in the preoperative CRP, IL-1β, and IL-6 levels, ESR, VAS score, or Harris hip score between the 2 groups (all P > .05). However, during the postoperative period, the PAI group exhibited significantly lower levels of CRP, IL-1β, and IL-6 as well as a lower ERS and VAS score compared with the control group (P < .05), while the Harris hip score was significantly higher postoperatively in the PAI group (P < .05). CONCLUSION Multimodal drug PAI can alleviate the inflammatory response and enhance hip function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures.
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Affiliation(s)
- Zhizheng Xiong
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Shuai Cao
- Department of Orthopaedics, Second Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Lingling Zhou
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Xu Zhang
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Qi Liu
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Jinxi Hu
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Fang Liu
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Yongwei Li
- Department of Orthopaedics, Second Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
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Rhee SM, Kim MS, Kim JD, Ro K, Ko YW, Rhee YG. Hematologic Expression After Shoulder Surgery: Normalization Curve of Serum Inflammatory Markers. Arthroscopy 2021; 37:71-82. [PMID: 32971139 DOI: 10.1016/j.arthro.2020.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the normalization curves of the serologic markers including white blood cell (WBC) count, WBC differential for segmented neutrophil (WBC seg.), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) after elective shoulder surgery and to investigate the hematologic differences among different shoulder surgeries. METHODS Seventy-seven patients underwent arthroscopic rotator cuff repair (RCR, group A), 44 patients had open rotator cuff repair (group B), and 84 patients had shoulder arthroplasty (group C). Peak and normalization times of markers were determined at preoperatively, postoperative day (POD) 1 and 2 days, 1 and 2 weeks, 1, 2, 3, 6 months, and 1 year after surgery. The normal ranges of serologic markers were set to WBC 4000 to10,000/μL, WBC seg. 40% to 60%, ESR 0 to 20 mm/h, and CRP 0 to 0.8 mg/dL. RESULTS Groups reached peak mean WBC count and WBC seg. on POD 1; mean WBC count started decreasing on POD 2 but was within normal value afterwards. Mean WBC seg. decreased to normal value at 1 month postoperatively in group A and B and at 2 months postoperatively in group C. Mean ESR peaked at 2 weeks postoperatively and normalized after 1 month in groups A and B and 3 months in group C. Mean CRP levels peaked on POD 2 in all groups and normalized within 2 weeks postoperatively in groups A and B and 1 month postoperatively in Group C. Normalized values of WBC count, WBC seg., and ESR varied widely. In contrast, CRP showed a consistent undetectable median, upper and lower quartile values less than 0.5 after normalization. Mean serum ESR and CRP values at peak time were significantly greater in group C than in the other groups (P = .001). CONCLUSIONS The mean CRP levels were normalized at 2 weeks after rotator cuff repair and at 1 month after arthroplasties. Unlike the other serologic markers, CRP had consistent normalized values of median, upper and lower quartile afterwards. The peak levels of the inflammatory markers were greater and therefore normalized slower following more invasive surgery. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Seo Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University at Gangdong, Seoul, Korea
| | - Jong Dae Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Wan Ko
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea.
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Klingebiel S, Theil JC, Gosheger G, Schneider KN, Timme M, Schorn D, Liem D, Rickert C. Postoperative Trends of Serum C-Reactive Protein Levels after Primary Shoulder Arthroplasty-Normal Trajectory and Influencing Factors. J Clin Med 2020; 9:jcm9123893. [PMID: 33266181 PMCID: PMC7760886 DOI: 10.3390/jcm9123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background-Postoperative serum C-reactive protein (CRP) is an important diagnostic parameter for systemic inflammation and reflects surgical trauma. While trends and normal trajectories after total knee (TKA) or hip arthroplasty (THA) are established, there is no reference standard for shoulder arthroplasty (SA). Therefore, the aim of this study was to research CRP trends and influencing factors following SA. Methods-This retrospective study analyzed postoperative serum CRP levels and trajectories in 280 patients following SA. Influence of prosthesis design, sex, operating time, BMI, and humeral augmentation with bone cement were analyzed using descriptive statistics and (non-) parametric testing. Results-There is a CRP trend with a peak on day two or three, with a subsequent decrease until day seven. Reverse and stemmed prostheses show a statistically higher CRP peak than stemless prostheses or hemiarthroplasties (HA). There was no influence of gender, body mass index (BMI), operating time, or bone cement. Conclusion-The presented findings may contribute to a better understanding of the postoperative CRP course after SA. The results of this retrospective study should be validated by a prospective study design in the future.
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Affiliation(s)
- Sebastian Klingebiel
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
- Correspondence: ; Tel.: +49-251-83-0
| | - Jan Christoph Theil
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
| | - Kristian Nikolaus Schneider
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
| | - Maximilian Timme
- Department of Forensic Medicine, Institute for Legal Medicine, University Hospital Muenster, 48149 Münster, Germany;
| | - Dominik Schorn
- Department for Shoulder and Elbow Surgery, Paracelsus Clinic Bremen, 28329 Bremen, Germany;
| | - Dennis Liem
- Sporthopaedicum Berlin, Medical Practice, 10627 Berlin, Germany;
| | - Carolin Rickert
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
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Nam JH, Cho MR, Lee SH, Song SK, Choi WK. C-reactive protein course after classical complication free total knee arthroplasty using navigation. Knee Surg Relat Res 2020; 32:56. [PMID: 33059760 PMCID: PMC7559145 DOI: 10.1186/s43019-020-00074-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The purpose is to estimate the degree of normalization of C-reactive protein (CRP) at 2 weeks and 4 weeks after uncomplicated total knee arthroplasty (TKA) using computer navigation. We also wish to determine whether the degree of normalization of CRP at 2 and 4 weeks differs after TKA performed in one knee and after TKA performed sequentially in both knees. We also want to analyze the patient factors that may influence the normalization of CRP. MATERIAL AND METHODS We studied 400 knees who underwent primary computer-navigated TKA for treatment of advanced osteoarthritis: the TKAs were all performed by the same surgeon. We retrospectively analyzed CRP levels during the preoperative period, the early postoperative period (5-7 days), the 2-week postoperative period (12-14 days), and the 4-week postoperative period (25-30 days). We have assumed gender, age, body mass index (BMI), staged bilateral TKA, and preoperative CRP as the potential patient factors associated with CRP normalization. RESULTS In unilateral TKA, CRP was normalized in 94 cases (34.3%) and in 219 cases (81.4%) within 2 weeks and 4 weeks after surgery, respectively. In second-knee, staged bilateral TKA, CRP was normalized in 46 cases (35.1%) and in 104 cases (79.4%) within 2 weeks and 4 weeks after surgery, respectively. There were no statistical differences between unilateral TKA and second-knee, staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period. Compared to women, men were 1.99 times less likely to have normalized CRP at 2 weeks after surgery (P = 0.02). CONCLUSION CRP was less likely to normalize during the 2-week postoperative period in men than it is in women, while there was no difference between men and women in the normalization of CRP during the 4-week postoperative period. There were no statistical differences in the course of CRP levels after unilateral TKA and staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period.
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Affiliation(s)
- Jun Ho Nam
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Myung Rae Cho
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Seo Ho Lee
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Won-Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea.
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Chuan L, Linfeng G, Hongchang L, Xiaosong W, Huaxing L, Chao Z, Yu P, Bo T. Short-term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis. J Surg Oncol 2020; 123:271-277. [PMID: 33047338 DOI: 10.1002/jso.26238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/23/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The efficacy of pelvic floor peritoneum closure (PC) during endoscopic low anterior resection (E-LAR) of rectal cancer remains unclear. This study aimed to clarify whether pelvic floor PC affected short-term outcomes. METHODS The study group comprised patients with the pathologically confirmed diagnosis of rectal cancer who underwent E-LAR with pelvic floor PC or with no PC (NPC) between January 2013 and December 2018 in Southwest Hospital. After propensity score matching (PSM), 584 patients (292 who underwent PC and 292 who underwent NPC) were evaluated. Postoperative indicators, including the rates of complications, anastomotic leakage (AL), reoperation, and inflammation, were observed in the two groups. RESULTS No significant difference was observed in the rates of postoperative complications between the PC and NPC groups. The rates of AL were similar (11.3% vs. 9.2%, p = .414). However, the reoperation rate of patients in the PC group was significantly lower than that of patients in the NPC group after AL (36.4% vs. 11.1%, p = .025). The hospital costs were higher in the NPC leakage subgroup (p = .001). Additionally, the serum C-reactive protein levels were lower in the PC group on postoperative days (PODs) 1, 3, and 5, whereas procalcitonin levels on POD 1 and 3 were lower in the PC group but did not differ significantly on POD 5. CONCLUSION Pelvic peritonization did not affect the rate of complications, especially AL; however, it effectively reduced the reoperation and inflammation rates and reduced hospitalization costs. Other short-term outcomes were similar, which warrant the increased use of pelvic peritonization in endoscopic surgery.
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Affiliation(s)
- Li Chuan
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Gao Linfeng
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Liu Hongchang
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Wang Xiaosong
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Luo Huaxing
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhang Chao
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Peiwu Yu
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Tang Bo
- Department of General Surgery & Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
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van Dongen JC, Smits FJ, van Santvoort HC, Molenaar IQ, Busch OR, Besselink MG, Aziz MH, Groot Koerkamp B, van Eijck CHJ. C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study. HPB (Oxford) 2020; 22:1504-1512. [PMID: 32171648 DOI: 10.1016/j.hpb.2020.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/17/2019] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early detection of major complications after pancreatoduodenectomy could improve patient management and decrease the "failure-to-rescue" rate. In this retrospective cohort study, we aimed to compare the value of C-reactive protein (CRP) and white blood cell count (WBC) in the early detection of complications after pancreatoduodenectomy. METHODS We assessed pancreatoduodenectomies between January 2012 and December 2017. Major complications were defined as grade III or higher according to the Clavien-Dindo classification. Postoperative pancreatic fistula (POPF) was a secondary endpoint. ROC-curve and logistic regression analysis were performed for CRP and WBC. Results were validated in an external cohort. RESULTS In the development cohort (n = 285), 103 (36.1%) patients experienced a major complication. CRP was superior to WBC in detecting major complications on postoperative day (POD) 3 (AUC:0.74 vs. 0.54, P < 0.001) and POD 5 (AUC:0.77 vs. 0.68, P = 0.031), however not on POD 7 (AUC:0.77 vs. 0.76, P = 0.773). These results were confirmed in multivariable analysis and in the validation cohort (n = 202). CRP was also superior to WBC in detecting POPF on POD 3 (AUC: 0.78 vs. 0.54, P < 0.001) and POD 5 (AUC: 0.83 vs. 0.71, P < 0.001). CONCLUSION CRP appears to be superior to WBC in the early detection of major complications and POPF after pancreatoduodenectomy.
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Affiliation(s)
- Jelle C van Dongen
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
| | - F Jasmijn Smits
- Department of Surgery, Utrecht MC, University Medical Centre, Utrecht, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Utrecht MC, University Medical Centre, Utrecht, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - I Quintus Molenaar
- Department of Surgery, Utrecht MC, University Medical Centre, Utrecht, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M Hossein Aziz
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Casper H J van Eijck
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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Santana DC, Emara AK, Orr MN, Klika AK, Higuera CA, Krebs VE, Molloy RM, Piuzzi NS. An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E416. [PMID: 32824931 PMCID: PMC7558636 DOI: 10.3390/medicina56090416] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022]
Abstract
Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6-1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.
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Affiliation(s)
- Daniel C. Santana
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (A.K.E.); (M.N.O.); (A.K.K.); (V.E.K.); (R.M.M.)
| | - Ahmed K. Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (A.K.E.); (M.N.O.); (A.K.K.); (V.E.K.); (R.M.M.)
| | - Melissa N. Orr
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (A.K.E.); (M.N.O.); (A.K.K.); (V.E.K.); (R.M.M.)
| | - Alison K. Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (A.K.E.); (M.N.O.); (A.K.K.); (V.E.K.); (R.M.M.)
| | - Carlos A. Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA;
| | - Viktor E. Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (A.K.E.); (M.N.O.); (A.K.K.); (V.E.K.); (R.M.M.)
| | - Robert M. Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (A.K.E.); (M.N.O.); (A.K.K.); (V.E.K.); (R.M.M.)
| | - Nicolas S. Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (A.K.E.); (M.N.O.); (A.K.K.); (V.E.K.); (R.M.M.)
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Hamann C, Naumann CM, Addali M, Witt JH, Kollitsch L, Wagner C, Hamann M, Jünemann KP, Osmonov D. [Multicenter comparison of complications after robot-assisted and open simple prostatectomy]. Urologe A 2020; 59:565-572. [PMID: 32103288 DOI: 10.1007/s00120-020-01141-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Robot-assisted simple prostatectomy (RASP) is a relatively new minimally invasive procedure for surgical treatment to manage symptomatic, therapy-refractory benign prostate hyperplasia (BPH) in prostate volumes >80 cm3. Thus, postoperative morbidity based on Clavien-Dindo and hematological parameters in RASP and open simple prostatectomy (OSP) procedures are examined. PATIENTS AND METHODS We retrospectively reviewed a total of 78 patients: 39 patients underwent RAPS and 39 OSP. The following parameters were statistically evaluated and compared: age, PSA value, prostate volume, ASA score, duration of hospital stay, operative time, Hb decrease on postoperative (po) day 1 and in the 5 five po days, CRP peak in the first 5 po days and transfusion rate. RESULTS The comparison between RASP and standard OSP showed no significant differences regarding the mean patient age (73 vs. 74 years; p =0.54), PSA values (7.7 vs. 10.7 ng/ml; p =0.17), ASA score (2.2 vs. 2.3; p =0.26) and prostate volume (130 vs. 113 cm3; p =0.07). Patients in the RAPAE group had statistically significant longer surgery (178 vs. 110 min; p =<0.01) with a significantly smaller decrease in Hb on po day 1 (1.9 vs. 3.3 g/dl; p ≤0.01) and in the first 5 po days (2.4 vs. 4.2 g/dl; p ≤0.01), lower need for preserved blood (3% vs. 26%; p =0.01) and number of blood bags (0.1 vs. 1.3; p =0.01), a lower po Clavien-Dindo score (0.44 vs. 1.23; p =0.003) and lower CRP values (52 vs. 104 mg/l; p ≤0.01) in the first 5 po days. CONCLUSION RASP is a safe procedure that offers the advantage of reduced blood loss and blood bag consumption and rare complications due to the minimally invasive surgical method. The OSP group showed an increased occurrence of complications due to bleeding, leading to prolonged hospitalization and significantly increased need for blood transfusion. The lesser increase of CRP in RASP group is a result of the lower invasiveness of the robot-assisted procedure.
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Affiliation(s)
- C Hamann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland.
| | - C-M Naumann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - M Addali
- Klinik für Urologie, Kinderurologie und urologische Onkologie, Prostatazentrum Nordwest, St. Antonius Hospital Gronau GmbH, Gronau, Deutschland
| | - J H Witt
- Klinik für Urologie, Kinderurologie und urologische Onkologie, Prostatazentrum Nordwest, St. Antonius Hospital Gronau GmbH, Gronau, Deutschland
| | - L Kollitsch
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - C Wagner
- Klinik für Urologie, Kinderurologie und urologische Onkologie, Prostatazentrum Nordwest, St. Antonius Hospital Gronau GmbH, Gronau, Deutschland
| | - M Hamann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - K P Jünemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - D Osmonov
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
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Precision multiparameter tracking of inflammation on timescales of hours to years using serial dried blood spots. Bioanalysis 2020; 12:937-955. [PMID: 32253915 PMCID: PMC7372997 DOI: 10.4155/bio-2019-0278] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: High-frequency longitudinal tracking of inflammation using dried blood microsamples provides a new window for personalized monitoring of infections, chronic inflammatory disease and clinical trials of anti-inflammatory drugs. Results/methodology: Using 1662 dried blood spot samples collected by 16 subjects over periods of weeks to years, we studied the behavior of 12 acute phase response and related proteins in inflammation events correlated with infection, vaccination, surgery, intense exercise and Crohn's disease. Proteins were measured using SISCAPA mass spectrometry and normalized to constant plasma volume using low-variance proteins, generating high precision within-person biomarker trajectories with well-characterized personal baselines. Discussion/conclusion: The results shed new light on the dynamic regulation of APR responses, offering a new approach to visualization of multidimensional inflammation trajectories.
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Yu K, Matzapetakis M, Horvatić A, Terré M, Bach A, Kuleš J, Yeste N, Gómez N, Arroyo L, Rodríguez-Tomàs E, Peña R, Guillemin N, de Almeida AM, Eckersall PD, Bassols A. Metabolome and proteome changes in skeletal muscle and blood of pre-weaning calves fed leucine and threonine supplemented diets. J Proteomics 2020; 216:103677. [PMID: 32028040 DOI: 10.1016/j.jprot.2020.103677] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/21/2020] [Accepted: 02/02/2020] [Indexed: 01/07/2023]
Abstract
In pre-weaning calves, both leucine and threonine play important roles in growth and muscle metabolism. In this study, metabolomics, proteomics and clinical chemistry were used to assess the effects of leucine and threonine supplementation added to milk replacer on 14 newborn Holstein male calves: 7 were fed a control diet (Ctrl) and 7 were fed the Ctrl diet supplemented with 0.3% leucine and 0.3% threonine (LT) from 5.6 days of age to 53.6 days. At this time, blood and semitendinosus muscle biopsies were collected for analysis. Integrated metabolomics and proteomics showed that branched-chain amino acids (BCAA) degradation and mitochondrial oxidative metabolism (citrate cycle and respiratory chain) were the main activated pathways in muscle because of the supplementation. BCAA derivatives and metabolites related to lipid mobilization showed the major changes. The deleterious effects of activated oxidative phosphorylation were balanced by the upregulation of antioxidant proteins. An increase in protein synthesis was indicated by elevated aminoacyl-tRNA biosynthesis and increased S6 ribosomal protein phosphorylation in skeletal muscle. In conclusion, LT group showed greater BCAA availability and mitochondrial oxidative activity; as the muscle cells undergo greater aerobic metabolism, antioxidant defenses were activated to compensate for possible cell damage. Data are available via ProteomeXchange (PXD016098). SIGNIFICANCE: Leucine and threonine are essential amino acids for the pre-weaning calf, being of high importance for growth. In this study, we found that leucine and threonine supplementation of milk replacer to feed pre-weaning calves led to differences in the proteome, metabolome and clinical chemistry analytes in skeletal muscle and plasma, albeit no differences in productive performance were recorded. This study extends our understanding on the metabolism in dairy calves and helps optimizing their nutritional status.
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Affiliation(s)
- Kuai Yu
- Departament de Bioquímica i Biologia Molecular, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Manolis Matzapetakis
- ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Anita Horvatić
- ERA Chair Team, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - Marta Terré
- Departament of Ruminant Production, Institut de Recerca i Tecnologia Agroalimentàries Caldes de Montbui, 08140 Barcelona, Spain
| | - Alex Bach
- Departament of Ruminant Production, Institut de Recerca i Tecnologia Agroalimentàries Caldes de Montbui, 08140 Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Josipa Kuleš
- ERA Chair Team, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - Natalia Yeste
- Departament de Bioquímica i Biologia Molecular, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Néstor Gómez
- Departament de Bioquímica i Biologia Molecular, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Laura Arroyo
- Departament de Bioquímica i Biologia Molecular, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | | | - Raquel Peña
- Servei de Bioquímica Clínica Veterinària, Facultat de Veterinària, Universitat Autònoma de Barcelona Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Nicolas Guillemin
- ERA Chair Team, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - André M de Almeida
- LEAF, Instituto Superior de Agronomia, Universidade de Lisboa, Lisbon, Portugal
| | - Peter David Eckersall
- ERA Chair Team, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia; Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Anna Bassols
- Departament de Bioquímica i Biologia Molecular, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain; Servei de Bioquímica Clínica Veterinària, Facultat de Veterinària, Universitat Autònoma de Barcelona Cerdanyola del Vallès, 08193 Barcelona, Spain.
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Tothova C, Novotny J, Nagy O, Hornakova P, Zert Z, Varga M, Medvecky L, Vdoviakova K, Danko J, Petrovova E. Changes in the Acute-Phase Protein Concentrations and Activities of Some Enzymes in Pigs Following the Repair of Experimentally Induced Articular Cartilage Defects Using Two Types of Biocement Powder. Animals (Basel) 2019; 9:ani9110931. [PMID: 31703315 PMCID: PMC6912659 DOI: 10.3390/ani9110931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Articular cartilage reconstruction is aimed at the restoration of damaged joint cartilage. The use of bone cement is one type of method applicable for this reconstruction. The potential use of repair techniques must be evaluated by pre-clinical and clinical studies in animal models, including the assessment of some biochemical parameters. Acute-phase proteins are a class of proteins whose concentrations increase in response to injury or inflammation. They may serve as useful biomarkers for the evaluation of post-operative complications, as well as to reflect the extent of surgical trauma. Information regarding their usefulness after cartilage reconstruction are still limited. Similarly, little is known about the response of the organism to various reconstruction techniques and various biomaterials used for the repair of defects. This paper provides important information about the changes in the concentrations of acute-phase proteins and the activity of serum enzymes in pigs within the first 30 days following the repair of experimentally induced articular cartilage defects using tetracalcium phosphate/nanomonetite cement powder (C cement) and cement powder containing aminoacids (CAK cement). Marked inflammatory responses with increased acute-phase proteins concentrations were observed following the reconstruction of articular cartilage defects using both types of biocement powder. The results suggest, that the tetracalcium phosphate/nanomonetite cement powder without amino acids would be more suitable for possible cartilage repair in the human population. Abstract The objective of the study was to assess the usefulness of acute-phase proteins (APPs) and serum enzymes in the evaluation of post-operative state after cartilage reconstruction in an animal model (Sus scrofa domesticus). Fifteen clinically healthy female pigs were evaluated during the first 30 days after the repair of experimentally induced articular cartilage defects using two types of biocement powders. Animals were divided into groups according to the type of biocement powder used: CAK—with amino acids (n = 6), C—without amino acids (n = 6) and the control group (Ctr) was without biocement (n = 3). The concentrations of selected APPs—serum amyloid A (SAA), haptoglobin (Hp) and C-reactive protein (CRP), and the activities of some serum enzymes—creatine kinase (CK), alkaline phosphatase (AP), and lactate dehydrogenase (LD) were measured one day before the surgery and on days 7, 14, and 30 after the surgical intervention. The most significant changes during the evaluated period were observed in the concentrations of SAA (p < 0.001) and Hp (p < 0.001), with marked increase of values 7 days after surgery. There was a numerical, but not statistically significant, difference between CAK, C and Ctr groups (p > 0.05). Marked variations were observed also in the activities of the evaluated enzymes, with the most significant changes in the activity of AP in the CAK group (p < 0.001). Presented results suggest possible usefulness of some APPs and serum enzymes in the evaluation of post-operative inflammatory state after the reconstruction of articular cartilage defects.
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Affiliation(s)
- Csilla Tothova
- Clinic of Ruminants, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic;
- Correspondence: ; Tel.: +421-915-493-082
| | - Jaroslav Novotny
- Clinic of Swine, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic;
| | - Oskar Nagy
- Clinic of Ruminants, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic;
| | - Petra Hornakova
- Clinic of Horses, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic; (P.H.); (Z.Z.)
| | - Zdenek Zert
- Clinic of Horses, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic; (P.H.); (Z.Z.)
| | - Maros Varga
- Sport-arthro Centre, Privat Hospital Saca-Kosice, 040 15 Saca-Kosice, Slovak Republic;
| | - Lubomir Medvecky
- Institute of Materials Research SAS in Kosice, Watsonova 47, 040 01 Kosice, Slovak Republic;
| | - Katarina Vdoviakova
- Institute of Anatomy, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic; (K.V.); (J.D.); (E.P.)
| | - Jan Danko
- Institute of Anatomy, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic; (K.V.); (J.D.); (E.P.)
| | - Eva Petrovova
- Institute of Anatomy, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovak Republic; (K.V.); (J.D.); (E.P.)
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Sharouf F, Hussain RN, Hettipathirannahelage S, Martin J, Gray W, Zaben M. C-reactive protein kinetics post elective cranial surgery. A prospective observational study. Br J Neurosurg 2019; 34:46-50. [PMID: 31645141 DOI: 10.1080/02688697.2019.1680795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Post cranial surgery readmission, largely caused by surgical site infection (SSI), is a marker of patient-care quality requiring comprehensive discharge planning. Currently, discharge assessment is based on clinical recovery and basic laboratory tests, including C-reactive protein (CRP). Although CRP kinetics have been examined postoperatively in a handful of papers, the validity of CRP as a standalone test to predict SSI is yet to be explored.Methods: A prospective observational study was performed on adult patients undergoing elective cranial surgery over a 3-month period. Laboratory data; CRP, white cell count (WCC), neutrophil cell count (NCC), and clinical data were assessed pre and post-operatively and were evaluated as predictors for safe discharge. Readmission rates within 1 month were recorded.Results: In this study, 68 patients were included. About 8.6% were readmitted due to SSI. A postoperativepeak in CRP was seen on day 2 with a value of 57 in the non-readmitted group, and 115 in the readmitted group. CRP dropped gradually to normal levels by day 5 in the non-readmitted group. A secondary CRP rise at day 5 was noted in the readmitted group with a sensitivity, specificity, and negative predictive value of 71%, 90%, and 96%, respectively. Interestingly, our ROC analysis indicates that a CRP value of less than 65 predicts safe discharge with a sensitivity of 86%, specificity of 89% and negative predictive value of 98% of safe discharge (area under the curve, AUC: 0.782). No significant difference in other inflammatory markers was found between both groups.Conclusions: CRP increases postoperatively for 4-5 d which could be a physiological response to surgery, however, prolonged elevation or a secondary increase in CRP may indicate an ongoing infection. Our data validate the potential use of CRP levels to predict SSI. A multicentre study is warranted to investigate the role of CRP in predicting SSI.
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Affiliation(s)
- Feras Sharouf
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK.,Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Rahim N Hussain
- Neuroscience and Mental Health Research Institute (NMHRI), School of Medicine, Cardiff University, Cardiff, UK
| | | | - John Martin
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK
| | - William Gray
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK.,Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Malik Zaben
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK.,Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, School of Medicine, Cardiff University, Cardiff, UK
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Persistent Wound Drainage After Total Joint Arthroplasty: A Narrative Review. J Arthroplasty 2019; 34:175-182. [PMID: 30245124 DOI: 10.1016/j.arth.2018.08.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Persistent wound drainage after total joint arthroplasty (TJA) is an important complication with potential substantial adverse consequences, in particular periprosthetic joint infection. METHODS This review evaluated the available literature regarding several issues in the field of persistent wound drainage after TJA and offers a classification of persistent wound drainage and an algorithmic approach to the decision-making process. RESULTS Available literature addressing the diagnosis and treatment of persistent wound drainage after TJA is scarce and an evidence-based clinical guideline is lacking. This is partially caused by the absence of a universally accepted definition of persistent wound drainage. In patients with persistent wound drainage, clinical signs and serological tests can be helpful in the diagnosis of a developing infection. Regarding the treatment of persistent wound drainage, nonsurgical treatment consists of absorbent dressings, pressure bandages, and temporary joint immobilization. Surgical treatment is advised when wound drainage persists for more than 5-7 days and consists of open debridement with irrigation and exchange of modular components and antimicrobial treatment. CONCLUSION Based on this literature review, we proposed a classification and algorithmic approach for the management of patients with persistent wound drainage after TJA. Hopefully, this offers the orthopedic surgeon a practical clinical guideline by finding the right balance between overtreatment and undertreatment, weighing the risks and benefits. However, this classification and algorithmic approach should first be evaluated in a prospective trial.
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Shin WC, Do MU, Woo SH, Choi SH, Moon NH, Suh KT. C-reactive protein for early detection of postoperative systemic infections in intertrochanteric femoral fractures. Injury 2018; 49:1859-1864. [PMID: 30082110 DOI: 10.1016/j.injury.2018.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/10/2018] [Accepted: 07/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This retrospective cohort study investigated perioperative C-reactive protein (CRP) value for early detection of postoperative systemic infective complications in elderly patients with intertrochanteric femoral fracture. METHODS A total of 250 patients aged ≥65 years, with intertrochanteric femoral fractures that were surgically treated between January 2011 and December 2015 were included. CRP value was measured preoperatively and on postoperative day (POD) 3, 5, and 10, and analyzed with regard to postoperative systemic infections, delirium, and death within 1 year. The patients were divided into two groups according to postoperative systemic infection, and perioperative CRP responses between the two groups were comparedusing t-test (or Man-Whitney test where appropriate). The receiver operator characteristic (ROC) curves of CRP value were used to determine the best-supported cut-off values for identifying postoperative systemic infections. Systemic infections were reclassified as pulmonary and extra-pulmonary infections. RESULTS The mean CRP values preoperatively and on POD 3, 5, and 10 were 2.82, 10.10, 3.74, and 1.89 mg/dL, respectively. Postoperative systemic infections, delirium, and death within 1 year were noted in 35 (14.0%), 30 (12.0%), and 45 (18.0%) patients, respectively. The CRP value in patients with postoperative systemic infections significantly elevated on POD 5 and 10 (p < 0.001, p < 0.001), and cut-off values were 4.71 and 1.59 mg/dL on POD 5 and 10, respectively. Postoperative delirium and death within 1 year were observed more often in the group with postoperative systemic infections (p = 0.003, p = 0.014). Although preoperatively elevated CRP values did not influence the postoperative CRP responses, they were significantly associated with delirium (p = 0.015). CONCLUSIONS The CRP value on POD 5 is the earliest predictor of postoperative systemic infections in elderly patients with intertrochanteric femoral fractures that are managed surgically. Moreover, when the CRP value on POD 5 is >4.71 mg/dL, the possibility of postoperative systemic infections should be considered. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Won Chul Shin
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Min Uk Do
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Seung Hun Woo
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Sung Hoon Choi
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea.
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
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Bosch P, van den Kieboom J, Plate JDJ, IJpma FFA, Houwert RM, Huisman A, Hietbrink F, Leenen LPH, Govaert GAM. Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study. J Bone Jt Infect 2018; 3:130-137. [PMID: 30013894 PMCID: PMC6043470 DOI: 10.7150/jbji.26492] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/12/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction: Diagnosing Fracture-Related Infections (FRI) based on clinical symptoms alone can be challenging and additional diagnostic tools such as serum inflammatory markers are often utilized. The aims of this study were 1) to determine the individual diagnostic performance of three commonly used serum inflammatory markers: C-Reactive Protein (CRP), Leukocyte Count (LC) and Erythrocyte Sedimentation Rate (ESR), and 2) to determine the diagnostic performance of a combination of these markers, and the additional value of including clinical parameters predictive of FRI. Methods: This cohort study included patients who presented with a suspected FRI at two participating level I academic trauma centers between February 1st 2009 and December 31st 2017. The parameters CRP, LC and ESR, determined at diagnostic work-up of the suspected FRI, were retrieved from hospital records. The gold standard for diagnosing or ruling out FRI was defined as: positive microbiology results of surgically obtained tissue samples, or absence of FRI at a clinical follow-up of at least six months. The diagnostic accuracy of the individual serum inflammatory markers was assessed. Analyses were done with both dichotomized values using hospital thresholds as well as with continuous values. Multivariable logistic regression analyses were performed to obtain the discriminative performance (Area Under the Receiver Operating Characteristic, AUROC) of (1) the combined inflammatory markers, and (2) the added value of these markers to clinical parameters. Results: A total of 168 patients met the inclusion criteria and were included for analysis. CRP had a 38% sensitivity, 34% specificity, 42% positive predictive value (PPV) and 78% negative predictive value (NPV). For LC this was 39%, 74%, 46% and 67% and for ESR 62%, 64%, 45% and 76% respectively. The diagnostic accuracy was 52%, 61% and 80% respectively. The AUROC was 0.64 for CRP, 0.60 for LC and 0.58 for ESR. The AUROC of the combined inflammatory markers was 0.63. Serum inflammatory markers combined with clinical parameters resulted in AUROC of 0.66 as opposed to 0.62 for clinical parameters alone. Conclusion: The added value of CRP, LC and ESR for diagnosing FRI is limited. Clinicians should be cautious when interpreting the results of these tests in patients with suspected FRI.
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Affiliation(s)
- Paul Bosch
- Department of General Surgery, Subdivision of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Janna van den Kieboom
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost D J Plate
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank F A IJpma
- Department of General Surgery, Subdivision of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Marijn Houwert
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Albert Huisman
- Department of Clinical Chemistry and Haematology, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falco Hietbrink
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertje A M Govaert
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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Different Kinetics of Perioperative CRP after Hip Arthroplasty for Elderly Femoral Neck Fracture with Elevated Preoperative CRP. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2140105. [PMID: 29854731 PMCID: PMC5941767 DOI: 10.1155/2018/2140105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/15/2018] [Accepted: 01/31/2018] [Indexed: 11/30/2022]
Abstract
This study aimed to determine the kinetics of four inflammatory markers and to identify the variables that affect the natural kinetics of inflammatory markers in aged patients having hip fractures with and without elevated preoperative CRP. 240 elderly patients who have been operated on for femoral neck fracture with no infectious complications were divided into two groups on elevated preoperative CRP level (>10 mg/L). The temporal values of four inflammatory markers of WBC, neutrophil count (N) (%), ESR, and CRP were assessed eight times every other day until the 14th postoperative day. At 48–60 h postoperatively, mean CRP was markedly higher in patients with preoperatively elevated CRP than in those with nonelevated CRP (122.1 ± 65.9 and 73.7 ± 35.5, p < 0.001). However, the abrupt elevation of CRP in the elevated group was conversely decreased on the 4th-5th postoperative day, demonstrating similar kinetic curves with no significant differences between both groups. For WBC, N (%), and ESR, both groups showed similar patterns of temporal values 14 days after surgery regardless of preoperative CRP level. Our findings could be used as guidelines for patient discharge and during the follow-up period after surgery.
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Abstract
BACKGROUND To evaluate the relationship between surgical timing and 1-year mortality in patients requiring hip fracture repair. METHODS We analyzed all 720 patients (>65 years) who had hip fracture surgery between March 2005 and February 2015, identifying patients by ICD-9 diagnosis and procedure codes using electronic data query. Mortality data were obtained from the institutional database, state and Social Security Death Indices. The relationship between surgical timing (defined as the interval from admission to the start of surgery) and 1-year mortality was assessed using a multivariable logistic regression, adjusting for baseline clinical status and surgical factors. RESULTS Among the 720 patients, 159 patients (22%) died within 1 year. The median time from admission to surgery was 30 hours. A linear relationship between the surgical timing and 1-year mortality was demonstrated. Delaying surgery was significantly associated with increased 1-year mortality, odds ratio 1.05 (95% CI: 1.02-1.08) per 10-hour delay (P = 0.001). CONCLUSIONS A linear relationship was observed between surgical timing and 1-year mortality. Each 10-hour delay from admission to surgery was associated with an estimated 5% higher odds of 1-year mortality. Therefore, we suggest that hip fractures should be treated urgently similar to other time-sensitive pathology such as stroke and myocardial ischemia. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Sanford AM, Morley JE, McKee A. Editorial: Orthogeriatrics and Hip Fractures. J Nutr Health Aging 2018; 22:457-462. [PMID: 29582883 DOI: 10.1007/s12603-018-1007-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A M Sanford
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Posterolateral vs Direct Anterior Approach in Total Hip Arthroplasty (POLADA Trial): A Randomized Controlled Trial to Assess Differences in Serum Markers. J Arthroplasty 2017; 32:3652-3658.e1. [PMID: 28780222 DOI: 10.1016/j.arth.2017.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/17/2017] [Accepted: 07/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty has claimed to be a true tissue-sparing minimally invasive approach that has less tissue damage and a faster recovery when compared to the posterolateral approach (PLA). The aim of this randomized controlled trial is to measure the differences in serum markers and functional outcomes between the DAA and PLA for total hip arthroplasty. METHODS Forty-six patients were prospectively included and randomized for either the DAA (n = 23) or PLA (n = 23). All surgical procedures were performed by 3 well-trained orthopedic surgeons. The degree of tissue damage was assessed by measuring creatine kinase (CK) and C-reactive protein levels (CRP) preoperatively and 2 hours, 1 day, 2 weeks, and 6 weeks postoperatively. Generalized linear mixed models analyses were used to assess differences between serum markers over time; correction for possible confounding factors was performed. The Hip disability and Osteoarthritis Outcome Score and the Harris Hip Score were assessed preoperatively and 6 weeks postoperatively. RESULTS There were no differences in patient demographics. The DAA had a longer operative time (P = .001). CK and CRP levels increased postoperatively, but no significant differences between the groups were found on any of the time points. Functional outcomes were also similar in both approaches. CONCLUSION No difference in tissue damage measured with serum markers CK and CRP were found between the DAA and PLA for total hip arthroplasty.
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C-reactive protein levels for early detection of early postoperative complications after proximal femoral fracture surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:907-913. [DOI: 10.1007/s00590-017-2080-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022]
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Larsen M, Bayard C, Lepetitcorps H, Cohen-Bittan J, Appay V, Boddaert J, Sauce D. Elevated Neopterin Levels Predict Early Death in Older Hip-fracture Patients. EBioMedicine 2017; 26:157-164. [PMID: 29157836 PMCID: PMC5832560 DOI: 10.1016/j.ebiom.2017.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 12/11/2022] Open
Abstract
Our society faces a major challenge concerning management of the health and socio-economic burden caused by acute physical stress in the older population (+ 75 years). In particular, hip-fracture surgery (HFS) represents a major health care preoccupation, affecting 1.6 million patients worldwide, resulting in a significant drop in life quality and autonomy. The trauma is associated with 20–30% one-year mortality in the elderly. In the present study, we aim to identify factors, which influence and/or predict the outcome of elderly hip- fracture patients (HFP) post-surgery. Our objective was to identify biomarkers with a prognostic capacity of one-year mortality. We employed an observational cohort of HFP (n = 60) followed-up longitudinally during the first year post fracture. Clinical and biological data (n = 136), collected at arrival to hospital, were then compared to healthy controls (n = 42) and analyzed using a regularized logistic regression model with lasso penalty followed by 10-fold cross-validation of variables. We show that plasmatic neopterin levels, a molecule released by IFN-γ-activated macrophages, is predictive of mortality in HFP (ROC-AUC = 0.859). Moreover, neopterin measured at arrival to the hospital correlated negatively with the time of survival after HFS. Neopterin therefore represents a biomarker, which enables better follow-up of patients at risk of early death. Neopterin level, measured at arrival to hospital, is a robust predictive marker of one-year mortality in HFPs. Neopterin concentration correlated negatively with the time of survival after hip fracture surgery.
The growing incidence of hip fractures, due to demographically aging populations, represent an important burden for health care systems and for injured patients in terms of hospitalization, rehabilitation, needs for long-term care, change in autonomy and mortality. Hip fractures are associated with high rates of adverse outcome, but previous studies have not discovered methods to identify patients at high risk of pernicious clinical outcome or death. Here, we show that innate immune activation post hip fracture in older adults is associated with pernicious clinical outcome.
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Affiliation(s)
- Martin Larsen
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France
| | - Charles Bayard
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France
| | - Hélène Lepetitcorps
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France
| | - Judith Cohen-Bittan
- AP-HP, Service de gériatrie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Victor Appay
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, CR7, F-75013 Paris, France
| | - Jacques Boddaert
- AP-HP, Service de gériatrie, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, CR7, F-75013 Paris, France
| | - Delphine Sauce
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, CR7, F-75013 Paris, France.
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Kang KT, Son DW, Lee SH, Song GS, Sung SK, Lee SW. Variation of C-Reactive Protein and White Blood Cell Counts in Spinal Operation: Primary Fusion Surgery Versus Revision Fusion Surgery. KOREAN JOURNAL OF SPINE 2017; 14:66-70. [PMID: 29017299 PMCID: PMC5642098 DOI: 10.14245/kjs.2017.14.3.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/01/2017] [Accepted: 08/17/2017] [Indexed: 11/19/2022]
Abstract
Objective Serum C-reactive protein (CRP) concentrations and white blood cell (WBC) count are commonly used to identify postoperative wound infections. We investigated whether changes in serum CRP levels and WBC counts actually differed between patients undergoing revision spinal fusion surgery and those undergoing a primary fusion. Methods Patients who underwent posterolateral fusion (PLF) surgery at Pusan National University Yangsan Hospital between October 2013 and April 2015 were considered for this study. Sixty-seven patients with primary lumbar PLF (pPLF) and 21 with revision PLF (rPLF) were enrolled. A retrospective assessment of preoperative and postoperative CRP levels and WBC count was undertaken. Also, we gathered peak CRP day, and CRP normalization days. Comorbidity data were also obtained to evaluate any effects on the course of CRP and WBC count postoperatively. Results CRP levels peaked at 3 days after surgery. The maximum CRP values recorded for each group: 4.17 (standard deviation [SD], 4.18) mg/dL and 4.88 (SD, 3.03) mg/dL for pPLF and rPLF. This difference was not statistically significant (p=0.24). A rapid fall in CRP within 5–9 days was observed for both groups. Conclusion Out of our expectation, changes in CRP levels after spinal fusion surgery follow the same course regardless of whether it is a revision operation or not. Because of this result, both the primary PLF surgery and revision PLF surgery should be monitored using CRP in the similar way and the antibiotic administration should be determined.
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Affiliation(s)
- Kyung Tag Kang
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Geun Seong Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Torrens C, Santana F, Marí R, Puig L, Alier A. Serum C-reactive protein in patients undergoing elective shoulder arthroplasty. Prospective study. J Orthop Sci 2017; 22:858-861. [PMID: 28689929 DOI: 10.1016/j.jos.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/22/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of the study was to determine the normalization curve of the serum C-reactive protein (CRP) in elective shoulder arthroplasty. METHODS A prospective study including 58 consecutive patients who had undergone elective shoulder arthroplasty. Forty-one patients had received a Reverse Shoulder Arthroplasty, 13 a Total Shoulder Arthroplasty and 4 a Hemiarthroplasty. Based on a pilot study, blood samples to determine CRP values were obtained at baseline (1 h before surgery), on the 1st, 2nd, 6th, 8th and 14th postoperative days. All the patients included presented no postoperative complications during inpatient stay or any re-admission during the three months after surgery. RESULTS Mean CRP values showed a rapid increase on the 1st postoperative day (7-fold higher than the baseline in cuff tear arthropathy, 11-fold higher in primary osteoarthritis, 1-fold higher in acute fracture) and reached a peak on the 2nd postoperative day (14-fold higher than the baseline in cuff tear arthropathy, 24-fold higher in primary osteoarthritis and 2-fold higher in acute fracture). After the 2nd postoperative day CRP values began to slowly decrease reaching the normal range in the 14th postoperative day. CONCLUSIONS Serum CRP levels after elective shoulder arthroplasty rapidly increase to reach a maximum peak after the 2nd surgery day and then slowly decrease to return to normality on the 14th day. Knowing the normalization curve of CRP can be a helpful tool to help in the diagnosis of acute infections in elective shoulder arthroplasty.
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Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain.
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Raquel Marí
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Lluis Puig
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
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Liu HF, Ren QM, Wang ZB, Li X, Jiang S, Zhang JT, Wang HB. Comparison of acute phase protein and hemodynamic variables in dogs undergoing video-assisted thoracoscopic vs. open pneumonectomy. Exp Ther Med 2017; 13:2391-2398. [PMID: 28565853 DOI: 10.3892/etm.2017.4257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/20/2017] [Indexed: 01/08/2023] Open
Abstract
It has been demonstrated that video-assisted thoracoscopic surgery (VATS) is feasible and safe in humans and animal models. The aim of the present study was to compare the surgical outcome using VATS with that of the standard transthoracic approach for pneumonectomy in dogs, to determine the acute-phase reaction in VATS pneumonectomy, and to analyze the difference between VATS and the standard transthoracic approach. A total of 14 dogs were divided into two groups (n=7); one group underwent VATS and the other group underwent a transthoracic pneumonectomy. Pre-, intra- and post-operative physiologic parameters were monitored, in addition to the blood cell count and serum acute-phase protein (APP) concentrations. The APP and hemodynamic changes between the two approaches were analyzed. Mean surgical time in the VATS group (176.7 min) was significantly longer compared with the open group (132.4 min). All APP concentrations were significantly increased at day 1 postoperation and gradually decreased to preoperative concentrations. The serum concentration of C-reactive protein on day 3 and the white blood cell count on day 1 were significantly higher following surgery in the open group compared with the VATS group (P<0.05). No differences were observed in the physiological parameters between the two groups. Although VATS took longer, animals experienced smaller incision and less stress. Therefore, the VATS approach was satisfactory for total pneumonectomy.
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Affiliation(s)
- Hai-Feng Liu
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Qing-Ming Ren
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Zhi-Bo Wang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Xin Li
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Sheng Jiang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Jian-Tao Zhang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Hong-Bin Wang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
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Wagman Y, Segal O, Dudkiewicz I, Steinberg E. Markers of muscle damage for comparing soft tissue injury following proximal femur nail and dynamic hip screw operations for intertrochanteric hip fractures. Injury 2016; 47:2764-2768. [PMID: 27810151 DOI: 10.1016/j.injury.2016.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral neck fractures are the most common fractures among the elderly. The two operative approaches used for the treatment of AO/OTA 31 intertrochanteric fractures include an intramedullary device (proximal femoral nail [PFN]) or an extramedullary device (sliding/dynamic hip screw [DHS]). The aim of this study was to provide objective evidence of local soft tissue injury by measuring serum creatine phosphokinase (CPK), a biochemical marker, to quantify muscle damage and inflammation in patients treated by the two approaches. PATIENTS AND METHODS Medical data of 359 patients operated for intertrochanteric fractures with PFN (156 patients) or DHS (193 patients) were retrospectively reviewed. The fractures were classified according to AO/OTA classification. Perioperative and radiographic data were collected to ensure cohorts with similar characteristics. Serum CPK and serum hemoglobin (Hb) levels were measured preoperatively and on postoperative day 1 (POD1). Independent predictors of elevation in the levels of markers of inflammation and muscle damage were determined by a multivariate linear regression model. RESULTS The demographics were similar for the two groups. Our study population included 64.2% female patients. Preoperative serum CPK levels were available for 89 patients and POD1 serum CPK levels were available for all patients. One-hundred and thirteen of the 193 DHS patients (58%) and 14 of the 156 PFN patients (9%) had a stable fracture (AO/OTA 31A1, p<0.0001). The DHS patients had a greater increase between pre- and postoperative CPK levels compared to the PFN patients (DHS, δ=368 versus PFN, δ=65, p<0.0002). The PFN patients had a greater decrease in both the pre- and postoperative Hb levels compared to the DHS patients (Diff_Hb 0.27g/dl). The older the patient, the greater decreases in Diff_CPK compared to the younger ones. CONCLUSIONS Implementation of POD1 CPK blood levels as a biochemical marker of soft tissue injury provided quantitative evidence that patients whose intertrochanteric fracture was stabilized by a DHS suffered greater soft tissue injury compared to patients whose fracture was stabilized by a PFN.
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Affiliation(s)
- Yonathan Wagman
- Department of Plastic Surgery, Hadassah Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
| | - Ortal Segal
- Orthopaedic Division, Sourasky Tel-Aviv Medical Center, Tel-Aviv University, Israel
| | - Israel Dudkiewicz
- Orthopaedic Rehabilitation Unit, Department of Rehabilitation, Sourasky Tel Aviv Medical Center, Tel-Aviv University, Israel
| | - Ely Steinberg
- Orthopaedic Division, Sourasky Tel-Aviv Medical Center, Tel-Aviv University, Israel
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Windisch C, Brodt S, Roehner E, Matziolis G. The C-reactive protein level after total knee arthroplasty is gender specific. Knee Surg Sports Traumatol Arthrosc 2016; 24:3163-3167. [PMID: 27535675 DOI: 10.1007/s00167-016-4289-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Laboratory diagnostics are part of the routine before and after operations. In all specialist surgical disciplines, including orthopaedic surgery, the acute-phase protein CRP is used to detect inflammatory processes, especially infections. The potential influence of patient gender on the postoperative course of CRP after TKA implantation is still unclear. In order to achieve a more precise evaluation of the complication-free general CRP course after TKA, the objective of the present study is to test the hypothesis that the p.o. course and level of CRP is gender specific in the first 10 days after TKA. METHODS A total of 1068 consecutive patients who had been treated with a unilateral primary cemented total knee replacement due to primary osteoarthritis of the knee over a 36-month period were retrospectively included in the study. For all patients, the preoperative CRP value and the postoperative course of CRP from postoperative days 1-10 were recorded and tested for gender specificity. RESULTS On days 2-5 and 7-8 after surgery, men had significantly higher CRP values than women. The maximum difference was 45 mg/L on the fourth p.o. day (men 170 mg/L, women 125 mg/L, p = 0.019). CONCLUSION The present study was able to show, for the first time, that the complication-free course of CRP in the first 10 days after TKA implantation is gender specific. The impact of the finding on diagnostic is that the gender-specific CRP course provides a more precise evaluation of the complication-free course of CRP after TKA. These results have clinical relevance to the interpretation of postoperative CRP values in order to avoid unnecessary investigations such as puncture or surgical care in female and male patients with uncomplicated TKA. Level of evidence Diagnostic study, III.
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Affiliation(s)
- Christoph Windisch
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany.
| | - Steffen Brodt
- Orthopaedic Department, Friedrich-Schiller University Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Eric Roehner
- Orthopaedic Department, Friedrich-Schiller University Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department, Friedrich-Schiller University Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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