Features of stress reactions in patients with osteoarthritis and concomitant cardiac pathology depending on the type of surgical access in hip arthroplasty

Objective. To compare the features of stress reactions in patients with osteoarthritis and concomitant cardiac pathology before surgery and in the early period after total hip arthroplasty, depending on the type of surgical access. Materials and methods. The results of treatment of 90 patients who underwent total hip arthroplasty using the standard posterior approach (group 1) and modified posterior approach (group 2) were analysed. The levels of insulin, cortisol, glucose, interleukin–6 and tumour necrosis factor–α were determined, the HOMA index (Homeostasis model assessment) was calculated, and the pain status and function of the operated joint were assessed. Results. Throughout the study, pain intensity remained statistically significantly lower in patients undergoing a modified posterior approach. The values of the HOMA index at the beginning of the study were the same in both groups. In the case of a modified posterior approach immediately after surgery and on day 1, they were statistically significantly lower than in patients who underwent a standard posterior approach, on day 7 they differed almost statistically significantly (p = 0.08), and were lower. Similar dynamics were observed with regard to cortisolemia. The concentration of interleukin–6 and tumour necrosis factor–α during the first three stages of the study had no differences between the groups, and on day 7 after surgery this indicator in patients who underwent a modified posterior approach became statistically significantly lower. The assessment of hip joint function within 7 days after surgery was the same after both approaches, but in a month, in patients who underwent a modified posterior approach, the joint function became statistically significantly better. Conclusions. The modified posterior approach has advantages over the standard approach in total hip arthroplasty in patients with osteoarthritis and concomitant cardiac pathology.