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

Oelsner, William K.; Engstrom, Stephen M.; Benvenuti, Michael A.; An, Thomas; Jacobson, Richard A.; Polkowski, Gregory G.; Schoenecker, Jonathan G.

doi:10.1016/j.arth.2016.06.027

Cited by 34 publications

(21 citation statements)

References 40 publications

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“…Second, it would be better if the drained fluid samples were collected to detect local inflammatory factors. As reported in a previous study,[2223] there was a 1000-fold increase of IL-6 levels in drained fluid, comparing to the systemic concentrations in arterial blood of patients operated in thoracic scoliosis. Furthermore, what period of complications after surgery the CRP and IL-6 levels could predict is still unclear.…”

Section: Discussionsupporting

confidence: 74%

Relationship between Inflammatory Response and Estimated Complication Rate after Total Hip Arthroplasty

Chen

Wang

et al. 2016

Chinese Medical Journal

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Background:After total hip arthroplasty (THA), there is a noteworthy inflammatory response. The inflammatory response is associated with postoperative recovery and complications. However, there had been few reports on the relationship between inflammatory response and postoperative complication rate. The aim of the present study was to investigate early inflammatory response in the first 3 days after THA, and to identify the relationship between inflammatory response and estimated complication rate after surgery.Methods:It was a prospective, nonrandomized cohort study. There were 148 patients who underwent unilateral THA in our hospital enrolled. Blood samples were collected preoperatively in the morning of the surgery and at 24, 48, and 72 h after surgery. C-reactive protein (CRP) and interleukin-6 (IL-6) in peripheral blood were measured. The modified physiological and operative severity score for the enumeration of the morbidity (POSSUM) was recorded pre- and intra-operatively. Based on the score, estimated complication rate was calculated. Harris score was used to assess hip function before and after surgery.Results:IL-6 levels reached the peak at 24 h after surgery and CRP at 48 h. After that, both of the levels decreased. The mean Harris scores significantly increased from 41.62 ± 23.47 before surgery to 72.75 ± 9.13 at 3 days after surgery. The Harris scores after surgery did not have a significant relation with either IL-6 or CRP peak levels (P = 0.165, P = 0.341, respectively). Both CRP and IL-6 peak levels significantly and positively correlated with estimated complication rate after surgery. The estimated complication rate calculated using the POSSUM system was 43 cases of 148 patients. Actually, there were only 28 cases that were observed to get postoperative complications during hospitalization. However, there was no significant difference between estimated and observed complication rates (P = 0.078). In the group with complications, the CRP and IL-6 peak levels were significantly higher than those in the group without complications (both P < 0.001).Conclusions:There were significantly positive relationships between both peak levels of CRP and IL-6 and estimated complication rate after THA. Inflammatory response could predict the incidence of complications after THA.

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Section: Discussionsupporting

confidence: 74%

Relationship between Inflammatory Response and Estimated Complication Rate after Total Hip Arthroplasty

Chen

Wang

et al. 2016

Chinese Medical Journal

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“…This is probably due to the variable intra-operative soft tissue trauma with consecutive secretion, bleeding, and swelling as well as to individual post-operative reaction [4] .Blooding and damaged tissue caused by surgery will release in ammatory mediator like TNF-α, IL-1β, IL-6, IL-8, increasing vascular permeability, causing in ammatory exudation and thus leading to swelling and pain which is acute phase response (APR). APR is a systemic reaction to tissue injury and does not vary signi cantly difference in surgical techniques [9] .…”

Section: Discussionmentioning

confidence: 99%

Mirabilite with ice pack after Total Knee Arthroplasty: A Randomized Controlled Trial Study

Zhang

Zheng

et al. 2020

Preprint

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Background Total knee arthroplasty (TKA) is a well-established procedure for end-state arthritis of knee with complications such as swelling and pain. The aim of this study is to evaluate the effect of mirabilite with ice pack versus ice pack alone on relieving pain, reducing swelling, range of motion (ROM), and serum CRP level in patients after TKA. Methods Eighty patients undergoing primary unilateral TKA were randomly assigned to two groups (MIP group and WIP group). We used VAS to measure knee pain at 24 h, 48 h, and 72 h after the surgery respectively. Knee swelling degree was evaluated by measuring the girth of leg at the center of patella and 10 cm above and below it at the same frequency. The active ROM of the knee was measured by using a universal goniometer of plastic material at 72 h postoperatively. The serum CRP level was also measured at 72 h postoperatively. Results The MIP group showed statistically significant lower knee girth at 48 h (p༜0.05), 72 h (p < 0.05) postoperatively and VAS score at 72 h (P = 0.018) at postoperatively after TKA than WIP group. The ROM of MIP group were significantly wider than WIP group (P = 0.024). The CRP level (P = 0.036) and length of stay (LOS) (P = 0.037) of MIP group were significantly lower than WIP group. Conclusions Mirabilite with ice pack after TKA showed superiority in relieving pain, reducing swelling, and improving ROM than ice pack alone. Trial registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR-OCN-15006356. Registered 6 MAY 2015, http://www.chictr.org.cn/showproj.aspx?proj=10927

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“…On the one hand, the increase in fibrinogen after surgery and trauma is a common and well-known phenomenon but, on the other hand, FIBTEM MCF did not predict thrombosis in non-cirrhotic patients undergoing non-cardiac surgery [2,48]. …”

Section: Discussionmentioning

confidence: 99%

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study

Kamel

Hassanin

Ahmed

et al. 2018

Transfus Med Hemother

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Background: Hypercoagulability can lead to serious thromboembolic events. The aim of this study was to assess the perioperative coagulation status in liver transplant recipients with a tendency to hypercoagulability. Methods: In a prospective observational study (South African Cochrane Registry 201405000814129), 151 potential liver transplant recipients were screened for thrombophilic factors from October 2014 to June 2017, and 57 potential recipients fulfilled the inclusion criterion of presenting two or more of the following thrombophilic factors: low protein C, low protein S, low anti-thrombin, increased homocystein, increased antiphospholipid IgG/IgM antibodies, increased lupus anticoagulant, and positive Factor V Leiden mutation. Seven patients were excluded from the study because they fulfilled the exclusion criteria of cancelling the liver transplantation, oral anticoagulation, or intraoperative treatment with rFVIIa. Accordingly, 50 patients were included in the final analysis. Thromboelastometry (ROTEM) (EXTEM, INTEM and FIBTEM) and conventional coagulation tests (CCT) were performed preoperatively, during the anhepatic phase, post reperfusion, and on postoperative days (POD) 1, 3 and 7. ROTEM was used to guide blood product transfusion. Heparin was infused (60-180 U/kg/day) postoperatively for 3 days and then was replaced by low-molecular-weight heparin (20 mg/12 h). Results: FIBTEM MCF significantly increased postoperatively above reference range on POD 7 despite normal fibrinogen plasma concentrations (p < 0.05). Both EXTEM and INTEM demonstrated significant changes with the phases of transplantation (p < 0.05), but with no intra- or postoperative hypercoagulability observed. INTEM CT (reference range, 100-240 s) normalized on POD 3 and 7 (196.1 ± 69.0 and 182.7 ± 63.8 s, respectively), despite prolonged aPTT (59.7 ± 18.7 and 46.4 ± 15.7 s, respectively; reference range, 20-40 s). Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) were reported in 12.0% and 2.0%, respectively, mainly after critical care discharge and with high FIBTEM MCF values in 57% on POD 3 and 86% on POD 7. Receiver operating characteristics curve analyses of FIBTEM MCF were significant predictors for thromboembolic events with optimum cut-off, area under the curve and standard error on POD 3 (>23 mm, 0.779 and 0.097; p = 0.004) and POD 7 (>28 mm, 0.706 and 0.089; p = 0.020). Red blood cells (mean ± SD, 8.68 ± 5.81 units) were transfused in 76%, fresh frozen plasma (8.26 ± 4.14 units) in 62%, and cryoprecipitate (12.0 ± 3.68 units) in 28% of recipients. None of the recipients received intraoperative platelet transfusion or any postoperative transfusion. Main transplant indication was hepatitis C infection in 82%. 76% of recipients included in this highly selected patient population showed increased lupus anticoagulant, 2% increased antiphospholipid IgG/IgM antibodies, 20% increased homocysteine, 74% decreased anti-thrombin, 78% decreased protein C, 34% decreased protein S, and 24% a positive Factor V Leiden mutation....

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

Abstract: 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.

Cited by 34 publications

References 40 publications

Relationship between Inflammatory Response and Estimated Complication Rate after Total Hip Arthroplasty

Relationship between Inflammatory Response and Estimated Complication Rate after Total Hip Arthroplasty

Mirabilite with ice pack after Total Knee Arthroplasty: A Randomized Controlled Trial Study

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study

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