Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent
Abstract 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...
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| Veröffentlicht in: | The Journal of arthroplasty 2017-01, Vol.32 (1), p.309-314 |
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| container_title | The Journal of arthroplasty |
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| creator | Oelsner, William K., BS Engstrom, Stephen M., MD Benvenuti, Michael A., BS An, Thomas J., AB Jacobson, Richard A., MD Polkowski, Gregory G., MD MSc Schoenecker, Jonathan G., MD PhD |
| description | Abstract 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 TJA in a healthy population defined by the Charlson Comorbidity Index. Methods This retrospective study identified 180 healthy patients (Charlson Comorbidity Index |
| doi_str_mv | 10.1016/j.arth.2016.06.027 |
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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 TJA in a healthy population defined by the Charlson Comorbidity Index. Methods This retrospective study identified 180 healthy patients (Charlson Comorbidity Index <2) that underwent TJA by a single surgeon for primary osteoarthritis from 2013-2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at two and six weeks postoperative. Results Postoperative CRP peaked during the inpatient period and returned to baseline by two weeks. Fibrinogen peaked after CRP and returned to baseline by six weeks. Elevated preoperative CRP correlated with a more robust postoperative acute phase response for both THA and TKA, suggesting that a patient’s preoperative inflammatory state correlates with the magnitude of the postoperative acute phase response. Conclusion Measurement of preoperative acute phase reactants may provide an objective means to predict a patient’s risk for postoperative dysregulation of the acute phase response and complications.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2016.06.027</identifier><identifier>PMID: 27554779</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>acute phase response ; Acute-Phase Reaction - diagnosis ; Acute-Phase Reaction - etiology ; Acute-Phase Reaction - physiopathology ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Knee - adverse effects ; C-reactive protein ; C-Reactive Protein - analysis ; Female ; fibrinogen ; Fibrinogen - analysis ; healthy ; Humans ; Male ; Middle Aged ; Orthopedics ; Osteoarthritis, Hip - physiopathology ; Osteoarthritis, Hip - surgery ; Postoperative Period ; Retrospective Studies ; total joint arthroplasty</subject><ispartof>The Journal of arthroplasty, 2017-01, Vol.32 (1), p.309-314</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-8d6be65f2d2c837e077cc998e27921e96777438bd59e6be79c1a4e97a85c50693</citedby><cites>FETCH-LOGICAL-c510t-8d6be65f2d2c837e077cc998e27921e96777438bd59e6be79c1a4e97a85c50693</cites><orcidid>0000-0003-1924-5895</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883540316302947$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27554779$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oelsner, William K., BS</creatorcontrib><creatorcontrib>Engstrom, Stephen M., MD</creatorcontrib><creatorcontrib>Benvenuti, Michael A., BS</creatorcontrib><creatorcontrib>An, Thomas J., AB</creatorcontrib><creatorcontrib>Jacobson, Richard A., MD</creatorcontrib><creatorcontrib>Polkowski, Gregory G., MD MSc</creatorcontrib><creatorcontrib>Schoenecker, Jonathan G., MD PhD</creatorcontrib><title>Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Abstract 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 TJA in a healthy population defined by the Charlson Comorbidity Index. Methods This retrospective study identified 180 healthy patients (Charlson Comorbidity Index <2) that underwent TJA by a single surgeon for primary osteoarthritis from 2013-2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at two and six weeks postoperative. Results Postoperative CRP peaked during the inpatient period and returned to baseline by two weeks. Fibrinogen peaked after CRP and returned to baseline by six weeks. Elevated preoperative CRP correlated with a more robust postoperative acute phase response for both THA and TKA, suggesting that a patient’s preoperative inflammatory state correlates with the magnitude of the postoperative acute phase response. Conclusion Measurement of preoperative acute phase reactants may provide an objective means to predict a patient’s risk for postoperative dysregulation of the acute phase response and complications.</description><subject>acute phase response</subject><subject>Acute-Phase Reaction - diagnosis</subject><subject>Acute-Phase Reaction - etiology</subject><subject>Acute-Phase Reaction - physiopathology</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - analysis</subject><subject>Female</subject><subject>fibrinogen</subject><subject>Fibrinogen - analysis</subject><subject>healthy</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Osteoarthritis, Hip - physiopathology</subject><subject>Osteoarthritis, Hip - surgery</subject><subject>Postoperative Period</subject><subject>Retrospective Studies</subject><subject>total joint arthroplasty</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UlFrFDEQDqLYs_oHfJA8-rJnkt1sNiKF47CtUvDQ-hxy2bluzlxyJtnK9dc3y9WiPggDMzDf980w3yD0mpI5JbR9t53rmIc5K_WclGDiCZpRXrOqa0j7FM1I19UVb0h9gl6ktCWEUs6b5-iEiZKFkDN0txx01CZDtHfW3-A8AF6YMQNeDToB_gppH3wprMeXoF0eDnilswWfEz4PzoVfE-06ZO3w52B9xouyVAx7p1M-vMerCL01Wa8dYO17vCxqNuXCf4mebbRL8Oohn6Lv5x-vl5fV1ZeLT8vFVWU4Jbnq-nYNLd-wnpmuFkCEMEbKDpiQjIJshRBN3a17LqEghTRUNyCF7rjhpJX1KTo76u7H9Q56U0ZH7dQ-2p2OBxW0VX93vB3UTbhVgnEmKSkCbx8EYvg5QspqZ5MB57SHMCZFO85a3pJ2grIj1MSQUoTN4xhK1GSa2qrJNDWZpkgJJgrpzZ8LPlJ-u1QAH44AKGe6tRBVMsUBUy4bwWTVB_t__bN_6MZZb412P-AAaRvG6IsBiqrEFFHfpreZvoa2NWGyEfU9XI7APA</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Oelsner, William K., BS</creator><creator>Engstrom, Stephen M., MD</creator><creator>Benvenuti, Michael A., BS</creator><creator>An, Thomas J., AB</creator><creator>Jacobson, Richard A., MD</creator><creator>Polkowski, Gregory G., MD MSc</creator><creator>Schoenecker, Jonathan G., MD PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1924-5895</orcidid></search><sort><creationdate>20170101</creationdate><title>Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent</title><author>Oelsner, William K., BS ; Engstrom, Stephen M., MD ; Benvenuti, Michael A., BS ; An, Thomas J., AB ; Jacobson, Richard A., MD ; Polkowski, Gregory G., MD MSc ; Schoenecker, Jonathan G., MD PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-8d6be65f2d2c837e077cc998e27921e96777438bd59e6be79c1a4e97a85c50693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>acute phase response</topic><topic>Acute-Phase Reaction - diagnosis</topic><topic>Acute-Phase Reaction - etiology</topic><topic>Acute-Phase Reaction - physiopathology</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>C-reactive protein</topic><topic>C-Reactive Protein - analysis</topic><topic>Female</topic><topic>fibrinogen</topic><topic>Fibrinogen - analysis</topic><topic>healthy</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Osteoarthritis, Hip - physiopathology</topic><topic>Osteoarthritis, Hip - surgery</topic><topic>Postoperative Period</topic><topic>Retrospective Studies</topic><topic>total joint arthroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oelsner, William K., BS</creatorcontrib><creatorcontrib>Engstrom, Stephen M., MD</creatorcontrib><creatorcontrib>Benvenuti, Michael A., BS</creatorcontrib><creatorcontrib>An, Thomas J., AB</creatorcontrib><creatorcontrib>Jacobson, Richard A., MD</creatorcontrib><creatorcontrib>Polkowski, Gregory G., MD MSc</creatorcontrib><creatorcontrib>Schoenecker, Jonathan G., MD PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oelsner, William K., BS</au><au>Engstrom, Stephen M., MD</au><au>Benvenuti, Michael A., BS</au><au>An, Thomas J., AB</au><au>Jacobson, Richard A., MD</au><au>Polkowski, Gregory G., MD MSc</au><au>Schoenecker, Jonathan G., MD PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>32</volume><issue>1</issue><spage>309</spage><epage>314</epage><pages>309-314</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Abstract 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 TJA in a healthy population defined by the Charlson Comorbidity Index. Methods This retrospective study identified 180 healthy patients (Charlson Comorbidity Index <2) that underwent TJA by a single surgeon for primary osteoarthritis from 2013-2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at two and six weeks postoperative. Results Postoperative CRP peaked during the inpatient period and returned to baseline by two weeks. Fibrinogen peaked after CRP and returned to baseline by six weeks. Elevated preoperative CRP correlated with a more robust postoperative acute phase response for both THA and TKA, suggesting that a patient’s preoperative inflammatory state correlates with the magnitude of the postoperative acute phase response. Conclusion Measurement of preoperative acute phase reactants may provide an objective means to predict a patient’s risk for postoperative dysregulation of the acute phase response and complications.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27554779</pmid><doi>10.1016/j.arth.2016.06.027</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1924-5895</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | acute phase response Acute-Phase Reaction - diagnosis Acute-Phase Reaction - etiology Acute-Phase Reaction - physiopathology Aged Aged, 80 and over Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Knee - adverse effects C-reactive protein C-Reactive Protein - analysis Female fibrinogen Fibrinogen - analysis healthy Humans Male Middle Aged Orthopedics Osteoarthritis, Hip - physiopathology Osteoarthritis, Hip - surgery Postoperative Period Retrospective Studies total joint arthroplasty |
| title | Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent |
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