Local vs. systemic immune and haemostatic response to hip arthroplasty.
Local and systemic immune and haemostatic responses were studied in 10 patients, aged 57-78 years, undergoing elective hip arthroplasty. Cytokines, soluble cytokine receptors, interleukin-1 receptor antagonist, soluble adhesion molecules, antithrombin, fibrin, soluble and fibrin D-dimer were analysed in wound drainage blood and in blood taken from the systemic circulation for up to 24 h post-operatively. Wound drainage blood concentrations of cytokines, interleukin-1 receptor antagonist and soluble cytokine receptors were increased compared with those in the systemic circulation except for the soluble interleukin-6 receptor. In wound drainage blood, soluble tumour necrosis factor receptors (P < 0.05), interleukin-1 receptor antagonist (P < 0.05) and interleukin-6 (P < 0.05-< 0.01) increased during the study period. In blood from the systemic circulation interleukin-6 increased (P < 0.05) while the soluble interleukin-6 receptor decreased (P < 0.05) compared with pre-operative values. Concentrations of soluble adhesion molecules did not change. Wound drainage blood showed marked hypercoagulation. After hip arthroplasty pro-inflammatory cytokines and their inhibitors were mainly confined to the local trauma site. A predominance for inhibitors was noted.
Kristiansson
M
M
Department of Anaesthesiology, Karolinska Institute, Huddinge University Hospital, Sweden.
Soop
M
M
Sundqvist
K G
KG
Soop
A
A
Suontaka
A M
AM
Blombäck
M
M
D000368:Aged; D000933:Antifibrinolytic Agents / Q000097:blood; D000990:Antithrombin III / Q000032:analysis; D019644:Arthroplasty, Replacement, Hip; D001777:Blood Coagulation / Q000276:immunology / Q000502:physiology; D016063:Blood Loss, Surgical; D015815:Cell Adhesion Molecules / Q000097:blood; D016207:Cytokines / Q000097:blood*; D017558:Elective Surgical Procedures; D005260:Female; D005337:Fibrin / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005500:Follow-Up Studies; D006487:Hemostasis / Q000276:immunology / Q000502:physiology*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008233:Lymphotoxin-alpha / Q000097:blood; D008297:Male; D008875:Middle Aged; D018121:Receptors, Cytokine / Q000097:blood; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors; D019947:Receptors, Interleukin-6 / Q000097:blood; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D015842:Serine Proteinase Inhibitors / Q000097:blood
D000933:Antifibrinolytic Agents; D015815:Cell Adhesion Molecules; D016207:Cytokines; D005338:Fibrin Fibrinogen Degradation Products; D018836:Inflammation Mediators; D015850:Interleukin-6; D008233:Lymphotoxin-alpha; D018121:Receptors, Cytokine; D017472:Receptors, Interleukin-1; D019947:Receptors, Interleukin-6; D018124:Receptors, Tumor Necrosis Factor; D015842:Serine Proteinase Inhibitors; C036309:fibrin fragment D; D000990:Antithrombin III; D005337:Fibrin