Correlation of local skin temperature of knee joint with C-reactive protein, interleukin 6 and erythrocyte sedimentation rate after primary unilateral total knee arthroplasty

doi:10.3969/j.issn.2095-4344.1287

Abstract

Abstract:

BACKGROUND: Periprosthetic infection is a most serious complication after total knee arthroplasty. It often causes the increase of local skin temperature. Skin temperature measurement is convenient and easy to implement.
OBJECTIVE: To understand the association of local skin temperature of the affected knee joint, with C-reactive protein, interleukin 6 and erythrocyte sedimentation rate after primary unilateral total knee arthroplasty without complications.
METHODS: Seventy patients undergoing primary unilateral total knee arthroplasty without complications at Department of Bone and Joint, Qingdao Municipal Hospital from January 2017 to January 2018 were selected. Informed consents were obtained from all patients and the study was approved by the Ethics Committee of the hospital. The local skin temperatures of both knee joints were measured at preoperative 1 day, and postoperative 1, 3, 6, 9, and 12 days and 1, 2, 3, 6, 9, and 12 months. The fasting blood samples were collected at baseline and 1, 3, 6, 9, and 12 days and 1, 2, and 3 months postoperatively to detect the C-reactive protein, interleukin 6 and erythrocyte sedimentation rate. The data were analyzed statistically.
RESULTS AND CONCLUSION: (1) Skin temperature of the affect knee at postoperative 1, 3, 6, 9, and 12 days and 1, 2, 3, and 6 months was significantly higher than the baseline and the healthy knee (P < 0.05), and showed no significant difference at postoperative 9 and 12 months (P > 0.05). Skin temperature of both knees reached a peak at 1 day postoperatively, which gradually declined in the following nine months and returned to normal at 9 months postoperatively. (2) The interleukin 6 level at 1, 3, 6, and 9 days postoperatively was higher than preoperatively (P < 0.05), and returned to normal at 12 days postoperatively. C-reactive protein level at 1, 3, 6, 9, and 12 days postoperatively was higher than preoperatively (P < 0.05), and returned to normal at 1 month postoperatively. Interleukin 6 and C-reactive protein levels both reached a peak at 1 day postoperatively. Erythrocyte sedimentation rate at 1, 3, 6, 9, and 12 days and 1 month postoperatively was higher than preoperatively (P < 0.05), and returned to normal at 2 months postoperatively. Erythrocyte sedimentation rate reached a peak at 6 days postoperatively. (4) These results indicate that knee temperature, C-reactive protein, interleukin 6 and erythrocyte sedimentation rate have normal fluctuation, increase after surgery and return to normal gradually after total knee arthroplasty without complication. Changes of skin temperature are correlated with inflammatory indexes. The degree of inflammatory response can be assessed by detecting changes in skin temperature and it can be used to monitor early infection. Furthermore, it is not necessary to worry about the increased knee temperature if there are no other evidence of infection.

Key words: knee arthroplasty, skin temperature of knee joint, postoperative infection, C-reactive protein, interleukin 6, erythrocyte sedimentation rate, inflammatory response

CLC Number:

R459.9

Zang Wenhao, Song Jian, Teng Xueren, Zhang Qiliang. Correlation of local skin temperature of knee joint with C-reactive protein, interleukin 6 and erythrocyte sedimentation rate after primary unilateral total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(24): 3773-3779.

Figures/Tables 5

2.6 术后C-反应蛋白、白细胞介素6水平及红细胞沉降率变化趋势见表4。如表4所示，术前所有患者白细胞介素6、C-反应蛋白、红细胞沉降率水平均处于正常水平。白细胞介素6与C-反应蛋白均在术后1 d达到峰值，红细胞沉降率于术后6 d达到峰值。白细胞介素6于术后快速上升，并于术后第1天达到峰值(26.45±6.20)ng/L；随后其水平快速下降，于术后12 d时降至正常值范围内(3.19±1.25)ng/L，与术前差异无显著性意义(t=-1.789，P=0.078)；术后1，2，3个月白细胞介素6水平与术前相比差异均无显著性意义(P > 0.05)。 C-反应蛋白同样于术后快速上升，于术后第1天达到峰值(116.38±21.33)mg/L；随后C-反应蛋白水平在术后逐渐下降，并于术后1个月时降至正常范围内(1.80± 0.68)mg/L，与术前差异无显著性意义(t=1.931，P=0.058)；术后2，3个月C-反应蛋白水平与术前相比差异均无显著性意义(P > 0.05)。相比C-反应蛋白与白细胞介素6的快速变化，红细胞沉降率则相对较慢。红细胞沉降率术后升高较缓慢，于术后第6天达到峰值(73.13±15.43)mm/h；随后其下降速度也相对较缓慢，于术后2个月恢复至正常范围，与术前水平差异无显著性意义(t=1.970，P=0.053)。 2.7 皮温与C-反应蛋白、白细胞介素6、红细胞沉降率的关系见表3，4。术后患膝皮肤温度较健侧显著升高，于术后第1天达到峰值，并在随后1年的随访过程中逐渐下降，于术后第9个月恢复至术前水平，术后第9个月与术后第12个月皮温与术前差异无显著性意义(P > 0.05)。术后C-反应蛋白、白细胞介素6、红细胞沉降率变化与皮温呈现类似变化趋势，术后均较术前水平显著升高，C-反应蛋白、白细胞介素6反应较迅速，于术后第1天达到峰值，红细胞沉降率反应相对缓慢，于术后第6天达到峰值。而后随皮温逐渐下降，C-反应蛋白、白细胞介素6、红细胞沉降率同样呈现出下降的趋势，白细胞介素6下降速度较快，于术后12 d降至正常值范围内；C-反应蛋白于术后1个月时降至正常值范围内；红细胞沉降率下降速度相对较慢，于术后2个月时降至正常范围内。 2.8 植入物与宿主的生物相容性膝关节假体生物相容性良好，所有患者均未出现植入物周围感染、过敏反应、免疫反应及排斥反应。"

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