Can Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) be elevated after hip fracture repair?

From the Guidelines

Yes, ESR and CRP can be elevated after hip fracture repair, as these inflammatory markers typically rise in response to surgical trauma and bone injury. According to the most recent study 1, these elevations are expected and don't necessarily indicate infection. CRP usually increases within 6-12 hours after surgery, peaking at 48-72 hours, and gradually returns to normal levels within 2-3 weeks if recovery proceeds without complications. ESR rises more slowly, often peaking at 5-7 days post-surgery, and may take 3-4 weeks to normalize.

Key Points to Consider

• Persistently high or rising levels of ESR and CRP beyond the expected timeframe, especially when accompanied by fever, increased pain, wound drainage, or other clinical signs of infection, should raise concern for potential complications such as surgical site infection or prosthetic joint infection.
• Regular monitoring of these inflammatory markers during the post-operative period can help distinguish between normal post-surgical inflammation and potential complications requiring intervention.
• The American Academy of Orthopaedic Surgeons (AAOS) guidelines strongly recommend the use of ESR, CRP, and serum interleukin-6 testing for patients being assessed for peri-prosthetic joint infection 1.
• Other diagnostic tools, such as joint aspiration and imaging studies, may be necessary to confirm the presence of infection.

Diagnostic Approach

• The combination of ESR and CRP can be a good screening tool for infection, with only one infected knee having negative results on both tests 1.
• Joint aspiration has been found to be extremely useful in diagnosing joint infection after total knee arthroplasty, with a sensitivity and specificity of 100% in some studies 1.
• The use of alpha-defensin laboratory test has also been described for the diagnosis of periprosthetic joint infection, with a sensitivity of 97% and a specificity of 96% for the diagnosis of periprosthetic joint infection 1.

From the Research

ESR and CRP Elevations after Hip Fracture Repair

• Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) can be elevated after hip fracture repair, as indicated by various studies 2, 3, 4, 5, 6.
• The degree of elevation and the duration of elevated levels can vary depending on the type of surgery, the presence of complications, and individual patient factors 2, 4, 5, 6.

Postoperative ESR and CRP Levels

• CRP levels typically peak on the second postoperative day and return to normal within 3 weeks after uncomplicated hip surgery 2, 4, 5, 6.
• ESR levels may remain elevated for a longer period, sometimes up to 3 months after surgery, even in the absence of complications 4, 5, 6.
• Elevated ESR and CRP levels can indicate the presence of complications such as infection or deep vein thrombosis 3, 5, 6.

Clinical Utility of ESR and CRP Monitoring

• Monitoring ESR and CRP levels can be useful in detecting postoperative complications and monitoring the effectiveness of treatment 5, 6.
• CRP is generally considered a more sensitive and informative marker than ESR for detecting infection and other complications after hip surgery 5, 6.