ACUTE PHASE PROTEINS AFTER ORTHOPAEDIC SURGERY
Abtullah MİLCAN1, Özlem KANDEMİR2, Gürbüz POLAT3, Celal BAĞDATOĞLU4, Mehmet ÇOLAK1, Fehmi KUYURTAR1
1University of Mersin, School of Medicine, Department of Orthopaedics and Traumatology
2University of Mersin, School of Medicine, Department of Clinical Microbiology and Infectious Diseases
3University of Mersin, School of Medicine, Department of Biochemistry
4University of Mersin, School of Medicine, Department of Neurosurgery
Keywords: Acute Phase Proteins; Acute Phase Reactants; Postoperative Infection; Musculoskeletal Trauma; Orthopaedic Surgery.
Introduction: Acute phase proteins (APP) are synthesised in the liver in response to tissue injury. The purpose of the study was to delineate the course of the circulating serum levels of various acute phase proteins after orthopaedic surgery and the effect of the length of the incision, transfusion, age and gender of the patient on these levels.
Patients and methods: C-reactive protein(CRP), alfa-1- acid glycoprotein, haptoglobulin (HPT), transferrin, ceruloplasmin levels, and erythrocyte sedimentation rate (ESR) were determined preoperatively (Term I), and on the 1st (Term II), 3rd (Term III), 5th (Term IV), 7th (Term V), 14th (Term VI) days after orthopaedic surgery which included soft tissue operations –group A (n=30), open reduction and internal fixation –group B (n=11), amputations -group C (n=10). Analysis of the outputs was done by repeated measures of covariance analysis; p<0.05 was considered significant. In CRP level measurement, since the variance was significantly large and the number of measurements was limited nonparametric Wilcoxon test was utilised.
Results: Infection or any other complication was not encountered in the study. CRP level changed between the terms in all operations (p<0.05). There was no difference between HPT levels in terms in group A, but they varied in groups B and C (p<0.05). In group A, and C there was no difference in ESR between the terms; in group B the mean level of ESR in term I was the lowest. Alfa-1-acid glycoprotein, Transferrin, Ceruloplasmin, Prealbumin levels were unchanged. CRP level was influenced by gender of the patient, and haptoglobulin level by length of the incision. There was a positive correlation between the ESR and age of the patient and length of the surgical incision (p<0.01).
Discussion: Knowledge about the natural course of ESR, and APP of which CRP and HPT are the most sensitive reactants may be helpful in the diagnosis of postoperative complications following orthopaedic surgery.