Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

Abstract

BackgroundWith an aging society and raised expectations, joint replacement surgery is likely to increase significantly in the future. The development of postoperative complications following joint replacement surgery (for example, infection, systemic inflammatory response syndrome and deep vein thrombosis) is also likely to increase. Despite considerable progress in orthopaedic surgery, comparing a range of biological markers with the ultimate aim of monitoring or predicting postoperative complications has not yet been extensively researched. The aim of this clinical pilot study was to test the hypothesis that lower limb orthopaedic surgery results in changes to coagulation, non-specific markers of inflammation (primary objective) and selective clinical outcome measures (secondary objective).MethodsTest subjects were scheduled for elective total hip replacement (THR) or total knee replacement (TKR) orthopaedic surgery due to osteoarthritis (n = 10). Platelet counts and D-dimer concentrations were measured to assess any changes to coagulation function. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as markers of non-specific inflammation. Patients were monitored regularly to assess for any signs of postoperative complications, including blood transfusions, oedema (knee swelling), wound infection, pain and fever.ResultsTHR and TKR orthopaedic surgery resulted in similar changes of coagulation and non-specific inflammatory biomarkers, suggestive of increased coagulation and inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in an increase in platelet (P = 0.013, THR) and D-dimer (P = 0.009, TKR) concentrations. Evidence of increased inflammation was demonstrated by an increase in CRP and ESR (P ≤ 0.05, THR and TKR). Four patients received blood transfusions (two THR and two TKR patients), with maximal oedema, pain and aural temperatures peaking between days 1 and 3 postoperatively, for both THR and TKR surgery. None of the patients developed postoperative infections.ConclusionsThe most noticeable changes in biological markers occur during days 1 to 3 postoperatively for both THR and TKR surgery, and these may have an effect on such postoperative clinical outcomes as oedema, pyrexia and pain. This study may assist in understanding the postoperative course following lower limb orthopaedic surgery, and may help clinicians in planning postoperative management and patient care.

Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps

“…In our series, an elevated platelet count > 490 × 10 9 /L was an independent predictor of vascular thrombosis, indicating its potential utility in identifying patients at high risk for flap complications. Increased platelet counts have been reported to contribute to hypercoagulability after traumatic injury and major surgical procedures, including coronary artery bypass grafting, abdominal surgery, and orthopedic joint replacement procedures . Although coagulation biomarkers have been widely investigated in coronary heart disease, limited attention has been directed toward the utilization and predictive value of platelet counts in patients undergoing free tissue transfer.…”

“…Increased platelet counts have been reported to contribute to hypercoagulability after traumatic injury and major surgical procedures, including coronary artery bypass grafting, abdominal surgery, and orthopedic joint replacement procedures. [31][32][33][34][35] Although coagulation biomarkers have been widely investigated in coronary heart disease, limited attention has been directed toward the utilization and predictive value of platelet counts in patients undergoing free tissue transfer. In a recent study of 47 free flaps by Mirzabeigi et al, 36 an elevated preoperative platelet count > 300 3 10 9 /L was predictive of unsuccessful flap salvage in the setting of vascular thrombosis following free flap reconstruction.…”

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

“…Due to the aging populations, the number of total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed is rapidly growing. 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.…”

“…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. 2,5 It is well established that D-dimer concentrations increase postoperatively, indicating increased coagulation activity.…”

Plasma level of D-dimer accompanying different types of gynecologic surgery and effects of prophylactic subcutaneous injection of heparin calcium

“…4 In total knee replacement surgery, it is reported the plasma D-dimer value is elevated during usage of tourniquet, elevated more on POD-1 and returned to normal range on POD-3. 5 In nonsurgical management of gastrointestinal ulcer bleeding, D-dimer level reflects fibrinolytic area on ulcer tissue and medication decreases D-dimer level. 6 We wished to ascertain the standard range of D-dimer level associated with each type of gynecologic surgery.…”