Comparison of physiological fluctuation in haematological parameters and vital signs in unilateral and bilateral uncomplicated total knee arthroplasty

Presenting Author - Ashish Singh Passi

Background : Human body reacts to the surgical stress of total knee arthroplasty (TKA). The inflammatory cascades are triggered to initiate the healing process. Due to that, fluctuation in haematological parameters and vital signs is seen after TKA. Body’s response is expected to be different for unilateral and bilateral TKA. Aim : To compare the variation in haematological parameters and vital signs in unilateral and bilateral TKA in early post operative period. Methods and Materials : All patients who underwent TKA at Medanta The Medicity Gurgaon from Oct ‘2016 to March ‘2017 were included in the study. Total 196 patients were enrolled in the study out of which 40 were unilateral and 156 bilateral. The Haematological samples (haemoglobin, total leucocyte count, platelets, blood urea, creatinine, sodium, potassium, total protein, albumin, ESR and CRP) were sent for all patients Pre-op and Post-op at specific time intervals and the variation in them was noted. The vital signs (heart rate, blood pressure, temperature, respiratory rate and SpO2) were regularly monitored while the patients were hospitalised and fluctuations were observed. The fluctuation in blood parameters and vital signs were then analysed with appropriate statistical analysis. Results : There is a fall in haemoglobin level after TKA. In U/L, 10% of patients had Hb < 9 gm/dl and in BL 16.7% on POD 1. The parameters indicating inflammatory response i.e., TLC, ESR and CRP rise in the perioperative period. On POD 1, Patients with TLC >10000/μL were 42.5 % of U/L and 52.6 % of B/L TKA; on POD 3, it was 42.5 % in U/L and 37.8 % in B/L. Platelets count were found to fall after TKA. There was no statistically significant difference in pre-op and post–op Blood urea, creatinine and potassium levels but there was definite fall in sodium levels. We also noticed hypoproteinemia after TKA. Fluctuation of heart rate and blood pressure, rise in body temperature, marginal rise in respiratory rate and fall in oxygen saturation in blood was also noted. Conclusion : The fluctuation in most of the haematological parameters and vital signs was found statistically comparable in both U/L and B/L TKA.