title: Relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses.
abstract: We studied the relationship between the neuroendocrine and inflammatory responses to hip arthroplasty and functional recovery in 102 patients undergoing elective arthroplasty for osteoarthritis. Blood samples were collected for up to 7 days after surgery and analysed for concentrations of norepinephrine, epinephrine, cortisol, interleukin-6 and C-reactive protein. The primary outcome measures were milestones in hospital, times to walk 10 and 25 m, pain on discharge from hospital, and function 1 and 6 months after surgery. Walking distances in hospital were significantly delayed in patients with greater interleukin 6 and C-reactive protein concentrations, but few neuroendocrine measures had significant correlations with functional recovery in hospital. Multivariate analysis showed that the interleukin 6 concentration on day 1 was the unique predictor of time to walk 10 and 25 m, and that the day 2 concentration of C-reactive protein was the unique predictor of pain on discharge from hospital. No significant correlations were found between the inflammatory and neuroendocrine variables and recovery at 1 and 6 months. We conclude that the inflammatory response affects immediate functional recovery after hip arthroplasty.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, St George's Hospital Medical School, London, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Hall
authors.forename: D
authors.initials: D
authors.lastname: Peerbhoy
authors.forename: A
authors.initials: A
authors.lastname: Shenkin
authors.forename: C J
authors.initials: CJ
authors.lastname: Parker
authors.forename: P
authors.initials: P
authors.lastname: Salmon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000097:blood; D015207:Osteoarthritis, Hip / Q000534:rehabilitation / Q000601:surgery*; D011184:Postoperative Period; D020127:Recovery of Function; D016138:Walking / Q000502:physiology
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D015850:Interleukin-6; D002097:C-Reactive Protein; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine