Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Abstract

Background The prevalence of obesity is increasing, and obesity often leads to degenerative joint disease requiring total hip arthroplasty (THA). Obesity is a proinflammatory state associated with an increase in chronic, low-grade inflammatory response. As such, it may augment the postoperative inflammatory response, which has been associated with postoperative pain and complications.Questions/purposes We determined whether severity of obesity was associated with (1) severity of inflammatory response, as measured by the in vivo circulating levels of cytokines and ex vivo functional reactivity of mononuclear blood cells, and (2) severity of pain, as measured by verbal pain scores and analgesic consumption, in the first 24 hours after THA. Methods We studied 60 patients (20 normal weight, 20 overweight, 20 obese) undergoing elective primary unilateral THA in this prospective cross-sectional study. Blood samples were collected for C-reactive protein and cytokine levels, including IL-1b, IL-2, IL-6, IL-8, and tumor necrosis factor a (TNF-a), from patients before and 24 hours after surgery. Cytokine response of whole blood was evaluated ex vivo with or without two standard activators, phorbol-12-myristate-13-acetate and lipopolysaccharide, using standardized blood sample from patients at 24 hours. These standard immune activators are implicated in the inflammatory response to gram-negative infection, translocation of microbial products, pathophysiology of septic shock syndrome in human, and tumor promotion. Pain response was gauged using verbal pain scores (on a 0-to 10-point scale, where 0 = no pain and 10 = worst pain) at rest and with activity at 24 hours after surgery and analgesic

Levels of Matrix Metalloproteinases in Arthroplasty Patients and Their Correlation With Inflammatory and Thrombotic Activation Processes

“…1,2 Although THA and TKA procedures have high success rates, complications are still present 1 and can include deep vein thrombosis (DVT), pulmonary embolism (PE), 3 and inflammation. 4 Many times, it is difficult or impossible to predict DVT/PE complications, as 50% of patients who have a postoperative DVT do not have an identifiable clinical risk factor. 2,3 D-Dimer is a fibrin breakdown product and a very sensitive marker for ruling out DVT or PE when levels are low.…”

“…2 Furthermore, postoperative inflammation can decrease immunity, delay healing, and increase the risk of infection. 4 Interleukin (IL) 1b, IL-6, and tumor necrosis factor a (TNF-a) can be used as markers for inflammation in arthroplasty patients. 1 Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases and are the main proteases that degrade collagen.…”

Diet, behavior and immunity across the lifespan

“…For instance, obese diabetic patients undergoing laproscopic Roux-en-Y gastric bypass surgery have a significantly greater increase in pro- and anti-inflammatory cytokines IL-6 and IL-10 than lean patients do after a similar surgery (Lin & Gletsu-Miller, 2013). Similarly, circulating cytokine levels following hip surgery have been correlated with BMI, implying the immune system is primed to over-react to immune stimuli in obese people (Motaghedi et al , 2013). Consistent with these findings in obese adult humans, neonatally overfed rats have exacerbated febrile and circulating pro-inflammatory cytokine responses to an immune challenge with bacterial endotoxin, LPS (Clarke et al , 2012).…”

The significance of post-operative rehabilitation in obese and overweight patients

“…Ogólna częstość hospitalizacji osób otyłych jest także więk-sza niż w przypadku pozostałej populacji [10][11][12]. Znany jest negatywny wpływ otyłości na śmiertelność i powikłania okołooperacyjne w chirurgii ogólnej [13][14][15][16][17][18], kardiochirurgii [19][20][21][22], urologii [23], chirurgii klatki piersiowej [24][25], ortopedii [26][27][28] i neurochirurgii [29]. Otyłość generuje więc For many years, the obesity epidemic has been observed in advanced countries, Poland included [1].…”

“…The general number of hospitalisations of obese patients is greater compared to other members of population [10][11][12]. The negative effects of obesity on mortality and perioperative complications in general surgery [13][14][15][16][17][18], cardiac surgery [19][20][21][22], urology [23], chest surgery [24][25], orthopaedics [26][27][28] and neurosurgery [29] are well known. dużo wyższe koszty opieki szpitalnej, jak i ambulatoryjnej [30][31][32].…”