Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent.

Autor: Oelsner WK; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; College of Medicine, The Medical University of South Carolina, Charleston, South Carolina., Engstrom SM; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Benvenuti MA; School of Medicine, Vanderbilt University, Nashville, Tennessee., An TJ; School of Medicine, Vanderbilt University, Nashville, Tennessee., Jacobson RA; Department of General Surgery, Rush University, Chicago, Illinois., Polkowski GG; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Schoenecker JG; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2017 Jan; Vol. 32 (1), pp. 309-314. Date of Electronic Publication: 2016 Jul 15.
DOI: 10.1016/j.arth.2016.06.027
Abstrakt: 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.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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