Evaluation of Post-operative Serum Biomarkers (D-Dimer, ESR, and CRP) in Patients Following Total Joint Arthroplasty: A Prospective Observational Study.

INTRODUCTION

Total joint arthroplasty, including total hip and knee replacement, is among the most successful orthopedic interventions for end-stage arthritis. However, complications, such as periprosthetic joint infection and venous thromboembolism remain significant causes of morbidity. Serum biomarkers, such as D-dimer, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), are commonly used to assess post-operative inflammation and potential complications. Despite extensive literature worldwide, normative post-operative biomarker trends in Indian patients remain poorly defined.

MATERIALS AND

METHODS

A prospective observational study was conducted in the Department of Orthopaedics, G.R. Medical College and J.A. Group of Hospitals, Gwalior, from October 2022 to June 2024. Fifty patients (25 total hip arthroplasty and 25 total knee arthroplasty) aged ≥50 years were enrolled. Serial serum D dimer, CRP, ESR, total leukocyte count, sodium, and calcium levels were measured pre-operatively and on post-operative days 1, 3, 5, 7, 14, and 28.

RESULTS

D-dimer exhibited a biphasic response - a rapid increase within 24 h (mean ≈ ×8.6 baseline), a fall by day 3, a secondary peak around day 10-14, and normalization by week 4. CRP peaked on day 3 and ESR on day 5, both showing a gradual decline thereafter. Mild transient post-operative hyponatremia was observed in 12% of cases. No infection or thromboembolic events occurred.

CONCLUSION

Transient elevations of D-dimer, ESR, and CRP represent the expected physiological ostoperative response after uncomplicated arthroplasty. Recognizing these normal patterns helps differentiate benign post-operative inflammation from infection or thrombosis, preventing unnecessary interventions.