Features of the body's adaptive mechanisms as a manifestation of systemic inflammatory response to surgical stress in patients with osteoarthritis and concomitant cardiac pathology after total hip arthroplasty

Objective. To study the degree of surgical stress and systemic inflammatory response after total hip arthroplasty using a modified posterior approach in patients with osteoarthritis and concomitant cardiac pathology Materials and Methods. The results of treatment of 55 patients who underwent total hip arthroplasty using a modified posterior approach were analyzed. The levels of insulin, cortisol, glucose, interleukin–6 and tumor necrosis factor–α were determined, the HOMA index (Homeostasis model assessment) was calculated, and pain status and hip function were assessed Results. The intensity of stress reactions was characterized by significant fluctuations during the study. Thus, the HOMA index had minimal values, although the difference between them was statistically significant immediately after surgery and a day later. Cortisol level after the operation increased statistically insignificantly, reached a statistically significant maximum in a day, and at the end of the study did not differ from the baseline value. The degree of severity of the systemic inflammatory response (concentration of interleukin–6 and tumor necrosis factor–α) also varied during the study. Thus, after the surgical intervention, the levels of both of these indicators increased statistically significantly, in a day the level of tumor necrosis factor–α decreased slightly, and the level of interleukin–6 did not change, on day 7 both indicators statistically significantly decreased to values lower than the baseline. The intensity of the pain syndrome, assessed by a visual analog scale, was most pronounced before surgery, a day after surgery it reached a maximum, although it was not great, on the 7th day the pain almost disappeared. The hip joint function score, determined by the Harris score, increased statistically significantly: from (56.1± 6.0) points (baseline values) to (84.3± 5.8) points (one month after surgery). Conclusions. It is important to take into account the extent of surgical intervention and it is necessary to introduce minimally invasive access to achieve better treatment results in patients with osteoarthritis and concomitant cardiac pathology.