title: Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent.
abstract: 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 total joint arthroplasty in a healthy population defined by the Charlson Comorbidity Index (CCI).
  
  
  
  This retrospective study identified 180 healthy patients (CCI < 2) who underwent total joint arthroplasty by a single surgeon for primary osteoarthritis from 2013 to 2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at 2 and 6 weeks postoperative.
  
  
  
  Postoperative CRP peaked during the inpatient period and returned to baseline by 2 weeks. Fibrinogen peaked after CRP and returned to baseline by 6 weeks. Elevated preoperative CRP correlated with a more robust postoperative APR for both total hip arthroplasty and total knee arthroplasty, suggesting that a patient's preoperative inflammatory state correlates with the magnitude of the postoperative APR.
  
  
  
  Measurement of preoperative acute phase reactants may provide an objective means to predict a patient's risk of postoperative dysregulation of the APR and complications.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; College of Medicine, The Medical University of South Carolina, Charleston, South Carolina.
authors.forename: William K
authors.initials: WK
authors.lastname: Oelsner
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Engstrom
authors.affiliation: School of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Benvenuti
authors.affiliation: School of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: An
authors.affiliation: Department of General Surgery, Rush University, Chicago, Illinois.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jacobson
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Polkowski
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Schoenecker
mesh_terms: D000210:Acute-Phase Reaction / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D005340:Fibrinogen; D002097:C-Reactive Protein
keywords: C-reactive protein; acute phase response; fibrinogen; healthy; total joint arthroplasty