Knee osteoarthritis is a leading cause of pain, disability, and reduced quality of life among middle-aged and older adults worldwide(1). Its global prevalence stands at 16.1% in individuals aged 15 years and older, affecting approximately 654 million people aged 40 and above in 2020 (2,3). Recent Global Burden of Disease studies project a substantial increase, with over 595 million OA cases worldwide in 2020, 453 million older adults affected in 2021, and 16 million disability-adjusted life years attributed to the condition(1). In the United States, around 60 million adults have OA, with the knee being the most commonly involved joint(4). The disease arises from progressive articular cartilage degradation, subchondral bone remodeling, synovial inflammation, and other joint structural changes, leading to pain, stiffness, swelling, reduced mobility, and functional impairment(2,5). While conservative treatments—such as lifestyle modifications, physical therapy, analgesics, and intra-articular injections—provide symptomatic relief, they fail to halt disease progression in advanced stages. Consequently, total knee arthroplasty is the definitive intervention, as it restores joint alignment, relieves pain, improves function, and delivers favorable patient-reported outcomes in end-stage OA. Degenerative and post-traumatic OA are the main indications for TKA(6), and demand is expected to surge, potentially reaching 3.5 million procedures annually in the US by 2030 due to population aging(7).

Although TKA yields excellent long-term outcomes—with modern studies reporting implant survival rates of 97.9% at 10 years and 97.6% at 15 years for any-cause revision(8–10) and national registries showing over 99.5% survival at 1 year and 95.6% at 10 years(11), patient satisfaction varies from 82% to 94%(8,9,12) Up to 20% of patients remain dissatisfied, often citing ongoing pain, stiffness, instability, neurogenic issues, and unmet expectations(8,11–15). Systematic reviews highlight persistent pain and functional limitations as the primary contributors(11,15). Postoperative physiological changes, including elevated knee skin surface temperature, are common and generally reflect normal healing from surgical trauma, increased local vascularity, tissue regeneration, and acute inflammation(7,16,17). Systematic reviews confirm transient SST elevation after TKA, typically peaking around postoperative day 2 and then gradually resolving. A meta-analysis of 318 patients reported a maximum ΔST of 2.8°C in the first 2 weeks, 1.4°C, at 3 months, and 0.6°C at 12 months(7,16,18–20). However, persistent hyperthermia may signal complications like infection, underscoring the importance of distinguishing normal from abnormal patterns to inform reassurance or intervention(7,16,18–20).

Conventional postoperative monitoring depends on invasive serological markers, including total leukocyte count, erythrocyte sedimentation rate, and C-reactive protein(21,22). In uncomplicated recoveries, these follow predictable patterns: TLC peaks at 24-48 hours; ESR rises gradually and normalizes over 6-8 weeks; and CRP surges sharply by days 2-3 before returning to baseline within 2-6 weeks(22–27). Under enhanced recovery protocols, CRP typically peaks around day 3 and normalizes by 2 weeks(25). Comparable trends appear in Indian populations, where CRP peaks on day 2 and normalizes by 3-12 weeks, depending on procedural extent(22,24).

Despite these well-defined systemic inflammatory profiles, the link between non-invasive knee SST—which may reflect local inflammation and correlate with CRP, ESR, and white blood cell count beyond 2 weeks—remains underexplored(7,16,18,25). Evidence indicates that SST changes align with inflammatory markers and show heightened sensitivity to local inflammation, persisting up to 6 weeks post-TKA(16,18). Combining systemic markers with localized SST measurements could improve early detection of complications, minimize unnecessary interventions, and optimize patient care.

This prospective observational study evaluated knee skin surface temperature and inflammatory markers following primary unilateral total knee replacement for OA over three months postoperatively. The primary objectives were to characterize the temporal patterns of knee skin surface temperature and inflammatory markers. The secondary objective was to investigate correlations between skin surface temperature and these markers.

MATERIAL AND METHODS

This prospective observational study was conducted within the Department of Orthopaedics at the All India Institute of Medical Sciences, Bhopal—an academic tertiary care hospital—to examine the association between postoperative knee skin surface temperature and systemic inflammatory markers among patients undergoing primary unilateral total knee replacement for osteoarthritis. Conducted over an 18-month period at this single center, the study enrolled participants who had undergone primary unilateral TKR for knee osteoarthritis, provided informed consent, and satisfied predefined inclusion and exclusion criteria.

Inclusion criteria comprised adults undergoing primary unilateral TKR for knee osteoarthritis who consented to participate in the study. Exclusion criteria included individuals undergoing revision TKR, bilateral procedures, or concurrent surgeries beyond primary arthroplasty; those declining informed consent; patients with inflammatory arthritis or autoimmune conditions; and those with prior TKR on the contralateral knee. Given the constrained study duration, convenience sampling was employed to maximize recruitment of eligible patients from the Department of Orthopaedics at AIIMS Bhopal, targeting a minimum sample size of 30.

Preoperative assessments were conducted the evening prior to surgery to establish baseline reference values, utilizing standardized patient information sheets and formalized consent forms for systematic data acquisition. These assessments included the collection of venous blood samples for analysis within standardized laboratory facilities to quantify inflammatory biomarkers—specifically total leukocyte count, erythrocyte sedimentation rate, and C-reactive protein—while skin surface temperature of both the operated and contralateral (control) knees was quantified using high-precision handheld infrared thermometer (Model: COR T800, 3V DC powered), with a measurement range of 34°C to 42.9°C and an accuracy of ±0.3°C .

Following the index procedure, all patients adhered to a standardized postoperative care protocol with longitudinal monitoring of inflammatory markers performed on postoperative days 1–2. Clinical examinations and SST measurements were systematically conducted at the initial dressing change and at defined follow-up intervals (POD 4–6, 14–16, 28–30, 6 weeks, and 3 months). To ensure thermometric precision and minimize environmental interference, a standardized equilibration protocol was implemented where both knees were exposed for a minimum of 3 minutes prior to recording to reach thermal equilibrium with the ambient room temperature.

All readings were obtained while the patient was at rest under consistent environmental conditions using a quadrant-based approach, with temperatures recorded from four distinct quadrants of each knee. For statistical analysis, the average of the two highest recorded values from each knee was utilized as the representative SST, and all data were managed via dedicated electronic spreadsheets to ensure accuracy and integrity.

Comprehensive data—including patient demographics, thermometric measurements, and systemic inflammatory marker concentrations—were prospectively recorded and managed using a dedicated electronic spreadsheet (Microsoft Excel; Microsoft Corp., Redmond, WA, USA) to ensure data integrity. Statistical processing was performed using the Statistical Package for the Social Sciences (SPSS) software. Descriptive statistics were utilized to summarize the clinical data, with continuous variables expressed as mean ± standard deviation and ranges.

Given that the data for skin surface temperature and inflammatory markers did not strictly follow a normal distribution, the Spearman rank correlation coefficient () was employed to evaluate their association(28,29). This non-parametric approach is suited for identifying monotonic relationships without linear assumptions(30). Correlation strength was interpreted using established thresholds for (28,29): very weak or negligible (0.00–±0.19); weak (±0.20–±0.39)(29,31); moderate (±0.40–±0.59); strong (±0.60–±0.79)(29,32); very strong (±0.80–±1.00)(31,32). Statistical significance was defined as a two-tailed .

The study adhered to ethical guidelines by obtaining informed consent from all participants, maintaining confidentiality, and minimizing risks. The design included measures to ensure participant comfort and safety during skin surface temperature assessments and blood sampling at follow-ups. Ethical approval was obtained from the Institutional Human Ethics Committee-Student Research of AIIMS Bhopal prior to commencement.

RESULTS

A total of 42 patients underwent total knee replacement (TKR) during the study period, including two cases of simultaneous bilateral procedures (44 knees). Four patients with prior contralateral TKR were excluded. Additionally, five patients were excluded due to underlying inflammatory conditions (rheumatoid arthritis, psoriasis vulgaris) or loss to follow-up. Thus, 31 patients undergoing primary unilateral TKR for osteoarthritis were included in the final analysis  .

Figure 1: Flow diagram showing patient selection and exclusion process for the study

The baseline characteristics of the study population are summarized in Table 1. The mean age of participants was 63.05 ± 7.73 years (range: 48–82 years), with the majority in the 56–65 years age group (54.8%). Females constituted 61.3% of the study population. The distribution of operated side was nearly equal (left: 51.6%, right: 48.4%).

Table 1:  Baseline Characteristics of Study Participants (n = 31)

Temporal changes in knee skin surface temperature are presented in Table 2. The operated knee temperature increased postoperatively, peaking on postoperative day (POD) 7 at 97.32 ± 0.53°F, followed by a gradual decline, approaching baseline values by 3 months.

At the 3-month follow-up, 74.2% (23/31) of patients had operated knee temperatures within ±1°F of their baseline (POD 0) values, while the remaining patients demonstrated mildly elevated temperatures, with no cases showing values below baseline. When compared to the contralateral knee at the same time point, 23 patients exhibited higher temperatures in the operated knee, whereas 8 patients had values within ±1°F, and none showed lower temperatures. The non-operated knee temperature remained relatively stable throughout the study period, with only minimal variation. The interlimb temperature difference increased postoperatively, reaching a peak of 3.28 ± 0.89°F on POD 7, followed by a gradual decline, approaching baseline levels by 3 months.

Table 2: Temporal changes in mean knee skin temperature (°F) of operated and non-operated limbs, and interlimb temperature difference across postoperative follow-up periods

Temporal trends in inflammatory markers are presented in Table 3. The total leukocyte count (TLC) demonstrated an early postoperative rise, peaking on postoperative day (POD) 2 at 9054.52 ± 2052.65/mm³, followed by stabilization and a gradual decline to near-baseline levels by 3 months. The erythrocyte sedimentation rate (ESR) showed a gradual increase, reaching a peak at POD 14–16 (30.69 ± 8.75 mm/hr), and subsequently declined steadily toward baseline by 3 months. In contrast, C-reactive protein (CRP) exhibited a sharp early rise, peaking on POD 2 at 110.72 ± 32.74 mg/L, followed by a rapid decline over subsequent follow-up periods, approaching near-baseline levels by 3 months.

Table 3: Temporal trends in inflammatory markers—total leukocyte count (TLC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)—across postoperative follow-up periods

Correlation analysis between operated knee skin surface temperature and inflammatory markers is summarized in Tables 4 and shown in Figures 2-4. A weak positive correlation was observed between knee temperature and total leukocyte count (TLC) (ρ = 0.38, 95% CI: 0.25–0.50; p < 0.001). The correlation with erythrocyte sedimentation rate (ESR) was very weak but statistically significant (ρ = 0.17, 95% CI: 0.03–0.31; p = 0.012). In contrast, a strong positive correlation was found between knee temperature and C-reactive protein (CRP) (ρ = 0.60, 95% CI: 0.50–0.68; p < 0.001).

Table 4: Correlation Between Knee Temperature and Inflammatory Markers

Figure 2: Correlation between operated knee skin surface temperature and total leukocyte count (TLC) following total knee replacement

Figure 3: Correlation between operated knee skin surface temperature and erythrocyte sedimentation rate (ESR) following total knee replacement

Figure 4: Correlation between operated knee skin surface temperature and C-reactive protein (CRP) following total knee replacement

Postoperative Complications

One patient developed a postoperative complication in the form of a patellar fracture, for which surgical management was planned. All remaining patients had an uneventful postoperative course, with no complications observed during the 3-month follow-up period.

DISCUSSION

This observational study, entitled “Assessment of Knee Skin Surface Temperature and Inflammatory Markers Following Primary Unilateral Total Knee Replacement: An Observational Study,” was conducted at the Department of Orthopaedics, AIIMS Bhopal, between February 2024 and August 2025. It examined the trajectories of skin surface temperature on the operated knee and systemic inflammatory markers among patients undergoing primary unilateral total knee replacement for osteoarthritis.

Postoperatively, skin surface temperature of the operated knee increased progressively, peaking on postoperative day 7, prior to a steady decline toward baseline levels by three months(7). In parallel, total leukocyte count exhibited an early surge followed by reduction; erythrocyte sedimentation rate rose more gradually; and C-reactive protein demonstrated a marked elevation on POD 2, subsequently normalizing progressively (22,24,33). Various devices have been utilized for postoperative knee temperature assessment, including contact thermometers (e.g., Genius First Temp Monitor (23,34–38)), infrared thermometers (e.g., IT 540E (18,39,40)), and thermal imaging cameras (e.g., NEC-Avio Thermo Shot F30S (41), FLIR E60 (42), or specialized medical systems (43)). Contact thermometers are prone to operator variability and reduced accuracy, whereas infrared modalities provide superior reproducibility(44). The current investigation employed a handheld digital infrared thermometer, facilitating non-invasive, cost-effective, and accurate measurements amenable to both clinical and domiciliary settings (7,20).

The operated knee attained a peak temperature of 97.32°F on POD 7, consistent with observations from previous studies (34,35,39,40,45), which documented peaks between POD 5–7. These congruences likely reflect similarities in follow-up schedules, osteoarthritis cohorts, patient positioning (supine or seated), anterior knee measurement sites, and acclimatization procedures. Conversely, some studies (18,37,38,41) reported delayed peaks, attributable to disparities in device resolution, positioning, exposure durations, follow-up timing, arthritis etiology, and environmental conditions. Contact thermometers in (38) and (37) omitted methodological details; (18) utilized 0.2°C resolution without specifying posture or exposure; while thermal imaging in (41,43) delineated broader thermal distributions, necessitating extended acclimatization (16,18).

At three months postoperatively, 23 of 31 patients exhibited operated knee temperatures exceeding the contralateral knee by >1°F, with 23 displaying elevations above POD 0 baselines. Prolonged monitoring to six months revealed no infections, with temperatures spanning 92–98°F, affirming physiological increments due to augmented vascular perfusion, metabolic activity, and superficial inflammation—typically 5–8 °C less than the core temperature(46)—under controlled conditions, rather than pathological processes. The postoperative elevation in knee skin surface temperature is multifactorial, encompassing surgical trauma-induced acute inflammation with cytokine-mediated vasodilation, heightened local perfusion, reactive hyperemia, and tissue metabolism during soft tissue and osseous repair(16,47). Resolution of inflammation and reparative progression culminate in normalization over weeks to months (7,16).

In the present cohort, TLC peaked on POD 2 at 9054.52 ± 2052.65/μL, declining to near-baseline by three months. Analogous POD 2 peaks with normalization by 3–5 weeks were noted (36,37,42,43). This profile mirrors acute neutrophil mobilization driven by cytokines and stress hormones, maximal at 24–48 hours, preceding abatement with convalescence (22,33). ESR peaked around POD 14, returning to near-baseline by three months(24,33). Similar 2-week apices with normalization by 3–5 weeks were evident (18,36,37,42). The protracted ascent signifies incremental acute-phase protein production fostering erythrocyte rouleaux formation amid sustained inflammation (24,26). CRP peaked on POD 2 at 110.72 ± 32.74 mg/L, normalizing by three months—mirroring patterns (18,23,36–39,41,42,45), with resolution by 3–5 weeks. Hepatic CRP synthesis, stimulated by cytokines, crests approximately 48 hours post-insult prior to decline (33,48).

Correlation analyses disclosed modest positive relationships between operated knee skin surface temperature and TLC or ESR, alongside a robust association with CRP(16). Moderate CRP-temperature correlations corroborated (37,41,42); attenuated TLC/ESR links aligned with previous studies (34,40). TLC's prompt, ephemeral surge contrasts protracted local hyperthermia; ESR's indolent, non-specific kinetics trail thermal changes; whereas CRP synchronizes with inflammation via interleukin-6 induction (7,16,18).

Strengths of this investigation encompass delineation of post-TKR baseline temperature dynamics, proposition of infrared thermometry as a non-invasive adjunct to laboratory assays, serial evaluations elucidating chronologic patterns, and correlations substantiating thermometric validity. Limitations comprise the modest single-institution sample, prospective environmental confounders, and three-month horizon potentially overlooking protracted alterations.

Prospective investigations ought to incorporate multicenter designs, extended surveillance, sophisticated imaging or artificial intelligence integration, revision/infection cohorts, methodological harmonization, economic evaluations, and applicability to diverse arthroplasties—fostering dependable self-monitoring paradigms.

CONCLUSION

In uncomplicated total knee replacement, operated knee skin temperature rises gradually post-surgery, peaks on postoperative day 7(34), and returns to baseline by three months(42). The inflammatory marker CRP peaks early on POD 2(22,33); ESR peaks around POD 3-5(22,24,33). Operated knee skin temperature, CRP, and ESR all normalize by three months(24,33,42). Knee temperature strongly correlates positively with CRP, mirroring inflammation(16). Larger multicenter studies with standardized protocols are needed. This pattern supports patient counseling, surgeon reassurance, and early detection of recovery deviations.

REFERENCES

1. Wang Y, Tang X, Peng J, Deng Y, Lan S, Yen Y, et al. Global, regional, and national burden of osteoarthritis among middle-aged and older adults: estimates from the global burden of disease study 2021 and projections to 2050. Frontiers in Medicine [Internet]. 2025 Dec 16 [cited 2026 Jan];12:1696929. Available from: https://doi.org/10.3389/fmed.2025.1696929      
2. Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine [Internet]. 2020 Nov 25 [cited 2026 Feb];100587. Available from: https://doi.org/10.1016/j.eclinm.2020.100587      
3. Naja MZ. Management strategies for knee osteoarthritis : innovation and health economic evaluation. HAL (Le Centre pour la Communication Scientifique Directe) [Internet]. 2022 Jun 28 [cited 2025 Aug]; Available from: https://theses.hal.science/tel-04008823      
4. Przkora R, Sibille KT, Victor SJ, Meroney M, Leeuwenburgh C, Gardner A, et al. Assessing the feasibility of using the short physical performance battery to measure function in the immediate postoperative period after total knee replacement. European Journal of Translational Myology [Internet]. 2021 Apr 7 [cited 2025 Oct];31(2). Available from: https://doi.org/10.4081/ejtm.2021.9673      
5. Guccione AA, Felson DT, Anderson JJ, Anthony J, Zhang Y, Wilson PWF, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. American Journal of Public Health [Internet]. 1994 Mar 1 [cited 2026 Apr];84(3):351. Available from: https://doi.org/10.2105/ajph.84.3.351      
6. Hsu H, Siwiec R. Knee Arthroplasty. In: StatPearls. StatPearls Publishing; 2024.
7. Gavish L, Kandel L, Rivkin G, Gertz SD, Hoffer O. Natural history of changes in knee skin temperature following total knee arthroplasty: a systematic review and meta-analysis. Scientific Reports [Internet]. Nature Portfolio; 2023 Apr 26 [cited 2025 Sep];13(1). Available from: https://doi.org/10.1038/s41598-023-33556-7      
8. Scott CEH, Bell KR, Ng R, MacDonald DJ, Patton JT, Burnett R. Excellent 10-year patient-reported outcomes and survival in a single-radius, cruciate-retaining total knee arthroplasty. Knee Surgery Sports Traumatology Arthroscopy [Internet]. 2018 Oct 1 [cited 2026 Jan];27(4):1106. Available from: https://doi.org/10.1007/s00167-018-5179-9      
9. Scott CEH, Snowden G, Cawley W, Bell KR, MacDonald DJ, Macpherson GJ, et al. Fifteen-year prospective longitudinal cohort study of outcomes following single radius total knee arthroplasty. Bone & Joint Open [Internet]. 2023 Oct 24 [cited 2025 Aug];4(10):808. Available from: https://doi.org/10.1302/2633-1462.410.bjo-2023-0086.r1      
10. Oliver WM, Arthur C, Wood A, Clayton RAE, Brenkel IJ, Walmsley P. Excellent Survival and Good Outcomes at 15 Years Using the Press-Fit Condylar Sigma Total Knee Arthroplasty. The Journal of Arthroplasty [Internet]. 2018 Mar 27 [cited 2025 Sep];33(8):2524. Available from: https://doi.org/10.1016/j.arth.2018.03.048      
11. Nakano N, Shoman H, Olavarría F, Matsumoto T, Kuroda R, Khanduja V. Why are patients dissatisfied following a total knee replacement? A systematic review. International Orthopaedics [Internet]. Springer Science+Business Media; 2020 Jul 8 [cited 2025 Oct];44(10):1971. Available from: https://doi.org/10.1007/s00264-020-04607-9      
12. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient Satisfaction After Total Knee Replacement: A Systematic Review. HSS Journal® The Musculoskeletal Journal of Hospital for Special Surgery [Internet]. SAGE Publishing; 2018 Jun 5 [cited 2025 Oct];14(2):192. Available from: https://doi.org/10.1007/s11420-018-9614-8      
13. STAUNTON DM, Mohan R, Carter J, HIGHCOCK AJ. Total knee replacement survivorship by Design Philosophy: are we ignoring medial pivot design? Analysis based on the UK National Joint Registry. Acta Orthopaedica Belgica [Internet]. 2023 Mar 30 [cited 2025 Oct];89(1):37. Available from: https://doi.org/10.52628/89.1.9913      
14. Lützner C, Beyer F, David L, Lützner J. Fulfilment of patients’ mandatory expectations are crucial for satisfaction: a study amongst 352 patients after total knee arthroplasty (TKA). Knee Surgery Sports Traumatology Arthroscopy [Internet]. 2023 Feb 6 [cited 2025 Oct];31(9):3755. Available from: https://doi.org/10.1007/s00167-022-07301-y      
15. Halawi MJ, Jongbloed W, Baron SL, Savoy L, Williams VJ, Cote MP. Patient Dissatisfaction After Primary Total Joint Arthroplasty: The Patient Perspective. The Journal of Arthroplasty [Internet]. 2019 Feb 5 [cited 2026 Jan];34(6):1093. Available from: https://doi.org/10.1016/j.arth.2019.01.075      
16. Xu H, Huang H, Yin L, Xiang S, Shang G, Zhang H, et al. Rapid Skin Temperature Measurement is Valuable in Evaluating Inflammation and Functional Status After Total Knee Arthroplasty：A Case Control Study. Research Square (Research Square) [Internet]. 2020 Jul 6 [cited 2025 Oct]; Available from: https://doi.org/10.21203/rs.3.rs-38832/v1      
17. Kurtz SM, Ong K, Lau E, Mowat F, Halpern MT. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. Journal of Bone and Joint Surgery [Internet]. 2007 Apr 1 [cited 2026 Apr];89(4):780. Available from: https://doi.org/10.2106/jbjs.f.00222      
18. Xu X, Sang W, Liu Y, Zhu L, Lu H, Ma J. Effect of Celecoxib on Surgical Site Inflammation after Total Knee Arthroplasty: A Randomized Controlled Study. Medical Principles and Practice [Internet]. 2018 Jan 1 [cited 2025 Oct];27(5):481. Available from: https://doi.org/10.1159/000492922      
19. Watts A, Boyle A, Kutuzov V, Warner C, Staniland T, Barlow G, et al. Current Use of Infrared Thermography in Orthopaedic and Bone or Joint Trauma Patients–Can We Identify Postoperative Infection? A Narrative Systematic Review. Strategies in Trauma and Limb Reconstruction [Internet]. Springer Nature; 2025 Mar 20 [cited 2025 Oct];19(3):141. Available from: https://doi.org/10.5005/jp-journals-10080-1630      
20. Glehr M, Stibor A, Sadoghi P, Schuster C, Quehenberger F, Gruber G, et al. Thermal Imaging as a Noninvasive Diagnostic Tool for Anterior Knee Pain Following Implantation of Artificial Knee Joints. International Journal of Thermodynamics [Internet]. 2011 May 10 [cited 2025 Oct];14(2). Available from: https://doi.org/10.5541/ijot.334      
21. Iwata E, Shigematsu H, Yamamoto Y, Ikejiri M, Okuda A, Sada T, et al. Temporal Evolution of White Blood Cell Count and Differential: Reliable and Early Detection Markers for Surgical Site Infection Following Spinal Posterior Decompression Surgery. Spine Surgery and Related Research [Internet]. 2021 Nov 3 [cited 2025 Sep];6(3):271. Available from: https://doi.org/10.22603/ssrr.2021-0105      
22. Krishna A, Garg SK, Gupta SK, Bansal H. C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) Trends following Total Hip and Knee Arthroplasties in an Indian Population – A Prospective Study. Malaysian Orthopaedic Journal [Internet]. 2021 Jul 1 [cited 2025 Oct];15(2):143. Available from: https://doi.org/10.5704/moj.2107.021      
23. Greidanus NV, Masri BA, Garbuz DS, Wilson SD, McAlinden MG, Xu M, et al. Use of Erythrocyte Sedimentation Rate and C-Reactive Protein Level to Diagnose Infection Before Revision Total Knee Arthroplasty. Journal of Bone and Joint Surgery [Internet]. 2007 Jul 1 [cited 2026 Mar];89(7):1409. Available from: https://doi.org/10.2106/jbjs.d.02602      
24. Londhe SB, Shah RV, Doshi AP, Londhe SS, Subhedar K. CRP (C Reactive Protein) level after total knee replacement in Indian population--- does it follow Anglo-Saxon trend? Arthroplasty [Internet]. 2020 Aug 27 [cited 2025 Aug];2(1). Available from: https://doi.org/10.1186/s42836-020-00043-7      
25. Huang Z, Huang Q, Wang LY, Lei Y, Xu H, Shen B, et al. Normal trajectory of Interleukin-6 and C-reactive protein in the perioperative period of total knee arthroplasty under an enhanced recovery after surgery scenario. BMC Musculoskeletal Disorders [Internet]. 2020 Apr 21 [cited 2025 Aug];21(1). Available from: https://doi.org/10.1186/s12891-020-03283-5      
26. Yang L, Wu B, Wang C, Li H, Bian W, Ruan H. Indicators and medical tests to identify lower limb swelling causes after total knee arthroplasty: a Delphi study with multidisciplinary experts. Journal of Orthopaedic Surgery and Research [Internet]. BioMed Central; 2023 Aug 5 [cited 2025 Oct];18(1). Available from: https://doi.org/10.1186/s13018-023-03980-6      
27. Mercurio M, Galasso O, Familiari F, Iannò B, Bruno CF, Castioni D, et al. Trend of Perioperative CRP (C-Reactive Protein) Levels in Non-Infected Total Knee Arthroplasty. Orthopedic Reviews [Internet]. PAGEPress (Italy); 2022 Jun 29 [cited 2025 Oct];14(3). Available from: https://doi.org/10.52965/001c.36589      
28. Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesthesia & Analgesia [Internet]. 2018 Feb 25 [cited 2026 Feb];126(5):1763. Available from: https://doi.org/10.1213/ane.0000000000002864      
29. Prion S, Adamson KA. Making Sense of Methods and Measurement: Spearman-Rho Ranked-Order Correlation Coefficient. Clinical Simulation in Nursing [Internet]. 2014 Sep 21 [cited 2026 Mar];10(10):535. Available from: https://doi.org/10.1016/j.ecns.2014.07.005      
30. Hauke J, Kossowski T. Comparison of Values of Pearson’s and Spearman’s Correlation Coefficients on the Same Sets of Data. Quaestiones Geographicae [Internet]. 2011 Jun 1 [cited 2025 Oct];30(2):87. Available from: https://doi.org/10.2478/v10117-011-0021-1      
31. - KPK, - VR. Significance of Spearman’s Rank Correlation Coefficient. International Journal For Multidisciplinary Research [Internet]. 2023 Aug 14 [cited 2025 Oct];5(4). Available from: https://doi.org/10.36948/ijfmr.2023.v05i04.5203      
32. Ņikitina M, Чернуха ИМ. Nonparametric statistics. Part 3. Correlation coefficients. Theory and practice of meat processing [Internet]. 2023 Oct 10 [cited 2025 Oct];8(3):237. Available from: https://doi.org/10.21323/2414-438x-2023-8-3-237-251      
33. Park KK, Kim TK, Chang CB, Yoon SW, Park KU. Normative Temporal Values of CRP and ESR in Unilateral and Staged Bilateral TKA. Clinical Orthopaedics and Related Research [Internet]. 2008 Jan 1 [cited 2025 Oct];466(1):179. Available from: https://doi.org/10.1007/s11999-007-0001-x      
34. Haidar SG, Charity R, Bassi RS, Nicolai P, Singh BK. Knee skin temperature following uncomplicated total knee replacement. The Knee [Internet]. 2006 Sep 30 [cited 2026 Jan];13(6):422. Available from: https://doi.org/10.1016/j.knee.2006.08.003      
35. Mehra A, Langkamer VG, Day AT, Harris S, Spencer R. C reactive protein and skin temperature post total knee replacement. The Knee [Internet]. 2004 Nov 9 [cited 2026 Jan];12(4):297. Available from: https://doi.org/10.1016/j.knee.2004.09.005      
36. Nazem K, Motififard M, Yousefian M. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011. Advanced Biomedical Research [Internet]. 2016 Jan 1 [cited 2026 Mar];5(1):148. Available from: https://doi.org/10.4103/2277-9175.187403      
37. Honsawek S, Chayanupatkul M, Tanavalee A, Sakdinakiattikoon M, Ngarmukos C, Tantavisut S. Relationship of serum C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty: A prospective study. IntOrthop. 2011;35:31.
38. Martinez V, Fletcher D, Bouhassira D, Sessler DI, Chauvin M. The Evolution of Primary Hyperalgesia in Orthopedic Surgery: Quantitative Sensory Testing and Clinical Evaluation Before and After Total Knee Arthroplasty. Anesthesia & Analgesia [Internet]. 2007 Aug 17 [cited 2026 Apr];105(3):815. Available from: https://doi.org/10.1213/01.ane.0000278091.29062.63      
39. Zeng YR, Feng W, Qi X, Li J, Chen J, Lu L, et al. Differential knee skin temperature following total knee arthroplasty and its relationship with serum indices and outcome: A prospective study. Journal of International Medical Research [Internet]. 2016 Sep 6 [cited 2026 Mar];44(5):1023. Available from: https://doi.org/10.1177/0300060516655237      
40. Hove RP van, Brohet RM, Royen BJ van, Nolte PA. No clinical benefit of titanium nitride coating in cementless mobile‐bearing total knee arthroplasty. Knee Surgery Sports Traumatology Arthroscopy [Internet]. 2014 Oct 4 [cited 2026 Mar];23(6):1833. Available from: https://doi.org/10.1007/s00167-014-3359-9      
41. Romanò CL, Romanò D, Dell’Oro F, Logoluso N, Drago L. Healing of surgical site after total hip and knee replacements show similar telethermographic patterns. Journal of Orthopaedics and Traumatology [Internet]. 2011 May 4 [cited 2026 Mar];12(2):81. Available from: https://doi.org/10.1007/s10195-011-0135-1      
42. Lohchab V, Singh J, Mahapatra PK, Bachhal V, Hooda A, Jindal K, et al. Thermal imaging in total knee replacement and its relation with inflammation markers. Mathematical Biosciences & Engineering [Internet]. 2021 Jan 1 [cited 2026 Jan];18(6):7759. Available from: https://doi.org/10.3934/mbe.2021385      
43. Yishake M, Xindie Z, He R. Value of knee skin temperature measured by infrared thermography and soluble intercellular adhesion molecule-1 in the diagnosis of periprosthetic knee infection in Chinese individuals following total knee arthroplasty. Chinese Medical Journal [Internet]. 2014 Sep 5 [cited 2025 Nov];127(17):3105. Available from: https://doi.org/10.3760/cma.j.issn.0366-6999.20140482      
44. Pecoraro VL, Petri D, Costantino G, Squizzato A, Moja L, Virgili G, et al. The diagnostic accuracy of digital, infrared and mercury-in-glass thermometers in measuring body temperature: a systematic review and network meta-analysis. Internal and Emergency Medicine [Internet]. Springer Science+Business Media; 2020 Nov 25 [cited 2025 Aug];16(4):1071. Available from: https://doi.org/10.1007/s11739-020-02556-0      
45. Shankar H, Phookan S, Singh MP, Bharti RS, Ahmed N, Yadav CP, et al. Asymptomatic low-density Plasmodium infection during non-transmission season: a community-based cross-sectional study in two districts of North Eastern Region, India. Transactions of the Royal Society of Tropical Medicine and Hygiene [Internet]. 2021 Jan 19 [cited 2025 Nov];115(10):1198. Available from: https://doi.org/10.1093/trstmh/trab017      
46. Park EB, Yazdi SJM, Lee J. Development of Wearable Temperature Sensor Based on Peltier Thermoelectric Device to Change Human Body Temperature. Sensors and Materials [Internet]. 2020 Sep 15 [cited 2025 Oct];32(9):2959. Available from: https://doi.org/10.18494/sam.2020.2741      
47. Sharma R, Werle J, Clark M, Puloski S, Kuchinad R, Johnston K, et al. Skin Temperature Following Total Knee Arthroplasty: A Longitudinal Observational Study. The Journal of Arthroplasty [Internet]. 2024 Jun 12 [cited 2026 Mar];39(10):2466. Available from: https://doi.org/10.1016/j.arth.2024.06.001     
48. Çalbıyık M. Clinical Outcome of Total Knee Arthroplasty Performed Using Patient-Specific Cutting Guides. Medical Science Monitor [Internet]. 2017 Dec 29 [cited 2025 Sep];23:6168. Available from:  https://doi.org/10.12659/msm.908213