Correlation between the Laboratory Test Results and Knee Functional Improvement of Pre-and Post-Total Knee Replacement Operation

Objective: This study aimed to identify correlations of laboratory test results and knee joint function between preand post-operation of knee joint replacement surgery. Methods: The study covered 60 75 aged 50 patients who had operated with knee replacement surgery. 25 patients were male and another 25 patients were female. We compared laboratory test results of preand 3, 7 and 14 day of post-operation. Moreover, pre-operation knee joint function was compared with 3, 7, 14 and 30 day of post-operation. Furthermore, we investigated the relationship among WBC, hemoglobin and function tests. Preand post-operative knee joint function tests were conducted by WOMAC (The Western Ontario and McMaster Universities Osteoarthritis), VAS (Visual Analogue Scale), TUG (Time up and Go) score, and MMT (Muscle Manual Test). Results: In pre-operation, patients’ average WBC was 6.447 ± 2.115 cells/μL, monocyte was 6.554 ± 3.101 cells/μL, lymphocyte was 31.177 ± 9.512 cells/μL and C-reactive protein was 0.6205 ± 0.922 mg/dL. In 3 day of post-operation, WBC was 8.901 ± 2.869 cells/μL, monocyte was 4.881 ± 2.332 cells/μL, lymphocyte was 17.048 ± 9.702 cells/μL and C-reactive protein was 4.2762 ± 2.293 mg/dL. There was a statistically significant difference reported on preand postoperation pain, stiffness and daily activity (P < 0.001). On the other hand, patients’ post-operative TUG score was significantly higher than pre-operative TUG scores (P < 0.0001). Furthermore, hemoglobin, red blood cell and TUG score of the 3 day of post-operation were raised up and they were statistically significant (P < 0.036). How to cite this paper: Lkhagvasuren, N., Chultemsuren, P., Dagvasumberel, M., Batbold, A., Baasanjav, Z., Khaltar, B., Nomkhondorj, O., Ombogo, B., Avirmed, E., Amgalanbaatar, A. and Sonomjamts, M. (2019) Correlation between the Laboratory Test Results and Knee Functional Improvement of Preand Post-Total Knee Replacement Operation. Open Journal of Orthopedics, 9, 48-60. https://doi.org/10.4236/ojo.2019.93005 Received: January 30, 2019 Accepted: March 8, 2019 Published: March 11, 2019 Copyright © 2019 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access N. Lkhagvasuren et al. DOI: 10.4236/ojo.2019.93005 49 Open Journal of Orthopedics In addition, WBC of pre-operation and 3, 7, 14 day of TUG score was significantly correlated (P < 0.04). Conclusion: Results of WBC, hemoglobin, hematocrit, total protein, total bilirubin, and creatinine had increased in 3 and 7 day of post-operation and had stabilized from 14 day of post-operation. Stiffness and TUG performance were controversially correlated in 3, 7, 14, 30 day of post-operation. However, in 7 and 14 of post-operation, patients’ muscle strength and knee joint amplitude had become stabilized and improved from 30 day of post-operation. Moreover, after the operation, the number of WBC controversially affected patients’ mobility. In addition, we found that as hemoglobin and red blood cells increased, walking ability improved as well.


Introduction
According to the World Health Organization (WHO) study in 1998-2015, the prevalence of Osteoarthritis (OA) is increasing 10% -15% year by year [1].
Moreover, the burden of musculoskeletal disability is increasing due to OA.In Mongolia, an incidence of OA and OA related surgery has been rising as well [1].Knee joint replacement surgery is one of the effective treatments.Moreover, studying laboratory test before and after the surgery is important.In addition, there is no study having reported in Mongolia about laboratory test of knee replacement surgery [2].Curtis et al. studied inflammatory factors after knee replacement surgery.The study reported that enhanced C-reactive protein, WBC and neutrophil percentage considered potential indicators to diagnose periprosthetic joint infection.It was usually developed by Staphylococcus epidermis and it was diagnosed by 5 -6 pieces' tissue of biopsy [3].
They studied about 2 stages of antibiotic treatment for 4 weeks before surgical treatment of prosthesis for infection detected patients [4].
As AAOS defined, optimal threshold for CRP and ESR was 149 mm/hour and 14.5 mg/dL in PJI knee [6].The average monthly cost for PJI knee was $50.000 while the average cost of a year was 250 million dollars among United States patients [7].
In 1974, the first patellar replacement was introduced as well as joint surface replacing.After that, scientists developed the method of installing prosthesis with bone-cement and retaining anterior and posterior cruciate ligaments [8].
In modern days, there are more than 19 companies producing 3 types of joint prosthesis.Internationally, many scientists have been studying laboratory test results of pre-and post-operation of total knee joint replacement [9].
Knee joint replacement surgery was introduced in Mongolia in 2000 with the help of orthopedic surgeons from France.Nowadays, the prevalence of osteoarthritis has been increasing in Mongolia Therefore, total knee joint arthroplasty is one of the notable treatments.
Moreover, the study of serologic markers before and after joint prosthesis surgery has never been done in Mongolia.

Materials and Methods
We've covered 60 -75 aged 50 patients who had operated with knee joint replacement surgery in National Trauma and Injury Hospital between June, 2017 and December 2018.25 patients were male and another 25 patients were female.
We compared patients' pre-and 3 rd , 7 th , 14 th day of post-operation laboratory test results and also pre-and 3 rd , 7 th , 14 th

Statistical Analysis
All statistical analysis made with Stata 13.0 IC program.We've summarized calculation of median and standard deviation of more than 2 times of (4 -5 times) laboratory tests measurements with a normal distribution.F value of Greenhouse Geisser test was used to find the correlation between groups.P value is less than 0.05 is considered as statistically significant.When it has a non-normal distribution, non-parametric Friedman test was used.Those repeated test results were represented by GraphPad Prism 7.0.

Ethical Statement
Ethical approval for this study was acquired from the Research Ethics Commit-

Result
In this study, we've covered 50 patients who have had total knee arthroplasty.
Patients' average age was 66.5 ± 9 and the gender ratio was 1:1.

Complete Blood Count Test
Patients' average WBC of pre-operation was  1).
Patients' WBC correlation between pre-and post-operation was identified by F value of Greenhouse Geisser test.As a test result, it was correlated statistically significant (P < 0.0001) (Figure 1).
However, there was no significant correlation of monocyte test result between pre-and post-operation (P > 0.405) (Figure 2).Even though, there was a significant correlation was observed lymphocyte result between pre-and postoperation (P < 0.05) (Figure 3).
Moreover, there was no significant correlation observed on CRP (P > 0.21).
Furthermore, there was no statistically significant difference in laboratory test result between male and female patients (P > 0.09) (Figure 4).When we identified the difference between pre-and post-operation red blood cell and hemoglobin, there was statistically, significant difference reported (P < 0.001) (Figure 5).
On the other hand, pre-operation hematocrit result was statistically dropped in post-operation (P < 0.001) (Figure 6).The number of platelet cells was statistically dropped after the operation as well (P < 0.047) (Figure 7).

Result of Biochemical Analysis
The patients' average ASAT result of pre-operation was 25.7 ± 15.9 U/L, average АLAT result was 29.8 ± 22.6 U/L, average total protein was 7.72 ± 4.78 g/dL, average total bilirubin was 0.61 ± 0.29 mg/dL and average creatinine was 0.69 ± 0.28 mg/dL.
There was a statistically significant difference reported on result of ASAT of pre and post-operation.It was analyzed by Greenhouse Geisser test (P > 0.061) (Figure 8).However, there was statistically significant difference reported on result of ALAT of pre and post-operation (P < 0.042) (Figure 9).Total protein was statistically decreased after operation (P < 0.001) (Figure 10).Total bilirubin was statistically dropped as well (P < 0.042) (Figure 11).
Also, result of creatinine was statistically different in pre and post-operation (P < 0.001) (Figure 12).

Result of Knee Function Tests
There were statistically significant improvements reported on pre and post-operation WOMAC test including pain, stiffness and daily activity (P < 0.001) (Figure 13).Furthermore, walking test result were significantly improved after surgery (P < 0.0001) (Figure 14).
Pain intensity was assessed by VAS score and patients' pain intensity were significantly dropped after surgery (P < 0.0001) (Figure 15).
There was a statistically significant correlation between result of hemoglobin, red blood cell and walking test in a 3 rd day of post-operation (P < 0.036) (Figure 18).and a statistically significant (P < 0.0001) [11].Furthermore, 2 nd day of post-operation, average WBC value was 10.5 × 10 6 cells/µL.However, in our study average WBC was 8.18 × 10 6 cells/µL and it has statistically significant difference (P < 0.0001).
In additionally, 14 th of post-operation, WBC was 8.03 × 10 6 cells/µL.In our study result of WBC was 7.30 × 10 6 cells/µL which means both studies recorded a drop of WBC result and it was statistically significant (P < 0.02).

Conclusions
In conclusion, pre-and post-operation laboratory test of total knee arthroplasty has changed following rehabilitation treatment.Therefore, an early exercise of post-operation is important.
Our study limitation is that patient follow-up time is short and can affect the absolute result of this study.However, we'll continue our study with longer follow-up time in the future.Moreover, we'll investigate prosthesis size for Mongolian people.

Table 1 .
Laboratory test results of pre and post operation.

Table 2 .
Biochemical analysis result of pre-and post-operation.
[15]l.have reviewed 28 patients who had infection after total knee arthroplasty between 2003 to 2012.As a result of this study, 60.7% of the patients were successfully treated with irrigation and debridement with component retention.Moreover, preoperative ESR, microorganism, and polyethylene liner exchange were factors need to be considered[13].etal.reported that 0.51% postoperative infection recorded from total 8494 cases of periprosthetic joint infection.The people who have obesity, diabetes, young age and higher than 40 BMI are affected by periprosthetic joint infection 3.3 times higher than others[15].Leighton et al. studied preoperative WBC value of 16,989 patients who underwent total knee arthroplasty and average WBC value before surgery was 7.38 × 10 6 cells/µL.In our study result, patients' average WBC was 6.447 × 10 6 N. Lkhagvasuren et al.DOI: 10.4236/ojo.2019.9300559OpenJournal of Orthopedics6.DiscussionKim Everhart