William K Oelsner1, Stephen M Engstrom2, Michael A Benvenuti3, Thomas J An3, Richard A Jacobson4, Gregory G Polkowski2, Jonathan G Schoenecker2. 1. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; College of Medicine, The Medical University of South Carolina, Charleston, South Carolina. 2. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 3. School of Medicine, Vanderbilt University, Nashville, Tennessee. 4. Department of General Surgery, Rush University, Chicago, Illinois.
Abstract
BACKGROUND: During surgery, trauma to musculoskeletal tissue induces a systemic reaction known as the acute phase response (APR). When excessive or prolonged, the APR has been implicated as an underlying cause of surgical complications. The purpose of this study was to determine the typical APR following total joint arthroplasty in a healthy population defined by the Charlson Comorbidity Index (CCI). METHODS: This retrospective study identified 180 healthy patients (CCI < 2) who underwent total joint arthroplasty by a single surgeon for primary osteoarthritis from 2013 to 2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at 2 and 6 weeks postoperative. RESULTS: Postoperative CRP peaked during the inpatient period and returned to baseline by 2 weeks. Fibrinogen peaked after CRP and returned to baseline by 6 weeks. Elevated preoperative CRP correlated with a more robust postoperative APR for both total hip arthroplasty and total knee arthroplasty, suggesting that a patient's preoperative inflammatory state correlates with the magnitude of the postoperative APR. CONCLUSION: Measurement of preoperative acute phase reactants may provide an objective means to predict a patient's risk of postoperative dysregulation of the APR and complications.
BACKGROUND: During surgery, trauma to musculoskeletal tissue induces a systemic reaction known as the acute phase response (APR). When excessive or prolonged, the APR has been implicated as an underlying cause of surgical complications. The purpose of this study was to determine the typical APR following total joint arthroplasty in a healthy population defined by the Charlson Comorbidity Index (CCI). METHODS: This retrospective study identified 180 healthy patients (CCI < 2) who underwent total joint arthroplasty by a single surgeon for primary osteoarthritis from 2013 to 2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at 2 and 6 weeks postoperative. RESULTS: Postoperative CRP peaked during the inpatient period and returned to baseline by 2 weeks. Fibrinogen peaked after CRP and returned to baseline by 6 weeks. Elevated preoperative CRP correlated with a more robust postoperative APR for both total hip arthroplasty and total knee arthroplasty, suggesting that a patient's preoperative inflammatory state correlates with the magnitude of the postoperative APR. CONCLUSION: Measurement of preoperative acute phase reactants may provide an objective means to predict a patient's risk of postoperative dysregulation of the APR and complications.
Authors: Rudy S Suidan; Mario M Leitao; Oliver Zivanovic; Ginger J Gardner; Kara C Long Roche; Yukio Sonoda; Douglas A Levine; Elizabeth L Jewell; Carol L Brown; Nadeem R Abu-Rustum; Mary E Charlson; Dennis S Chi Journal: Gynecol Oncol Date: 2015-05-31 Impact factor: 5.482
Authors: Peter V Giannoudis; Paul John Harwood; Peter Loughenbury; Martijn Van Griensven; Christian Krettek; Hans-Christoph Pape Journal: J Trauma Date: 2008-09
Authors: Cristina Rius; Gloria Pérez; José Miguel Martínez; Mara Bares; Anna Schiaffino; Rosa Gispert; Esteve Fernández Journal: J Clin Epidemiol Date: 2004-04 Impact factor: 6.437
Authors: Evan A Choate; Gurjit S Kaeley; Jenny Brook; Roy D Altman; John D FitzGerald; Astrid R Floegel-Shetty; David A Elashoff; Veena K Ranganath Journal: BMC Rheumatol Date: 2020-02-03
Authors: Breanne H Y Gibson; Matthew T Duvernay; Stephanie N Moore-Lotridge; Matthew J Flick; Jonathan G Schoenecker Journal: Res Pract Thromb Haemost Date: 2020-06-14