Changes and clinical significance of erythrocyte sedimentation rate, CRP and D-dimer in femoral neck fracture patients undergoing hip arthroplasty

Abstract

Objective To investigate the perioperative level of erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and D-dimer in femoral neck fracture patients undergoing hip arthroplasty and their clinical significance for the prognosis. Methods A total of 152 cases of hip arthroplasty were prospectively enrolled and divided into fracture group (femoral neck fracture) and non-fracture group (osteonecrosis of femoral head, hip osteoarthritis and developmental dysplasia of the hip). The ESR, CRP and D-dimer were measured before and after the surgery. Then their relation to postoperative infection, venous thrombosis and other complications were analyzed in more than 2 years follow-up. Results There were 72 cases in fracture group and 80 cases in non-fracture group. The mean follow-up period was 29±5 months ranging from 6 to 49 months, among which 138 cases (90.8%) were followed up more than 24 months. The preoperative ESR was (26.575±6.292) mm/h in fracture group and (16.743±4.235) mm/h in non-fracture group (t=11.353, P<0.01), with postoperative ESR (40.424±17.566) mm/h and (36.643±11.836) mm/h respectively. The preoperative CRP was (28.402±4.103) mg/L in fracture group, (5.666±1.692) mg/L (t=44.133, P<0.01) in non-fracture group with postoperative CRP (75.405±18.345) mg/L and (48.062±12.453) mg/L (t=10.812, P<0.05) respectively. The preoperative D-dimer was 1.61±0.83 mg/L in fracture group and (0.784±0.175) mg/L (t=8.346, P<0.01) in non-fracture group, with postoperative D-dimer (3.200±1.106) mg/L and (2.852±1.415) mg/L respectively. There was no case of periprosthetic joint infection (PJI) in either groups within two-years follow-up. There were 2 cases of deep venous thrombosis in the fracture group and 1 case in the non-fracture group, without pulmonary embolism in either group. The postoperative Harris score was (89±6) in fracture group and (86±14) in non-fracture group. Conclusion The preoperative ESR, CRP and D-dimer in femoral neck fracture patients often increase significantly. These abnormalities do not increase the risk of VTE or PJI postoperatively in those without proved preoperative infection or VTE. Key words: Blood Sedimentation; CRP protein; D-dimer; Arthroplasty, replacement, hip; Venous thromboembolism