Dynamics of Metabolic and Inflammatory Parameters in Overweight Patients Undergoing Knee or hip Arthroplasty

Abstract

Osteoarthritis is a common problem in overweight and obese individuals and may lead to severe forms located especially at the knee and hip joints. Arthroplasty in these cases represents the appropriate treatment to solve the pain and to improve joint mobility. This intervention influences the laboratory parameters in different ways. The aim of the study was to compare pre- and postoperative values of metabolic and inflammatory parameters related to joint replacement surgery in patients suffering from advanced stages of knee and hip osteoarthritis, and to assess the relationship between different laboratory findings, taking into consideration the main cardio-metabolic comorbidities. The study was conducted at the Clinic of Orthopaedics and Traumatology of the Clinical County Hospital Mures between 2016-2017 on 57 overweight patients having severe knee or hip osteoarthritis undergoing total knee or hip arthroplasty. Plasma metabolic tests (uricemia, glycemia, triglycerides, cholesterol) and inflammatory markers (fibrinogen, high sensitive C-reactive protein - hsCRP) were followed in the studied overweight patients in the morning just before arthroplasty and 24 h after surgery. Dynamics of the measured laboratory tests and the relationship between them were assessed. Body mass index, waist circumference and cardio-metabolic associated diseases have also been evaluated. Significant decrease of uricemia, cholesterolemia, plasma triglyceride concentration and significant increase of hsCRP could be observed after joint replacement surgery compared to the previous values measured before the intervention. Glycemia was slightly higher after the arthroplasty, but the difference is not quite significant. Negative correlation could be found between preoperative HDL-cholesterol and plasma triglyceride level, while triglyceride concentration showed positive correlation with LDL-cholesterol and uricemia. BMI showed positive correlation with postoperative fibrinogen values. Hypertension was the most frequent cardio-metabolic comorbidity in the studied group. Significant difference occured in the level of a sensitive inflammatory marker and several biochemical laboratory tests suffered notable changes before and after arthroplasty in the studied group. Metabolic status was deeply affected by such an intervention during the first day after surgery. Laboratory components of the metabolic syndrome were present in close relationship in several patients. Further studies need to be performed for the dynamic assessment of more complex metabolic and inflammatory parameters in patients with similar pathology in order to evaluate the postoperative evolution and to provide appropriate support for these patients in the recovery process.

Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review

“…Stress risers in the presence of thin cortices should be avoided [34,35]. The main contraindications are related to age/osteoporosis and, mostly, intraoperative periprosthetic femoral fractures [34,38]. 11,14,31].…”