title: Impact of the body mass index on perioperative immunological disturbances in patients with hip and knee arthroplasty.
abstract: BACKGROUND
  Obesity increases the risk for knee and hip joint implantation and negatively contributes to wound healing. In this study, in 52 patients undergoing hip and knee arthroplasty the amount of peripheral immune effector cells pre- and post-operative, as well as the expression of certain soluble factors affecting the functions of immune effector cells were investigated.
  
  
  METHODS
  The peripheral immune cells and the expression of the soluble factors were determined by flow cytometry and correlated to each other in dependency of the BMI, the sex, and the kind of arthroplasty.
  
  
  RESULTS
  The pre-operative amounts of peripheral NK cells and cytotoxic T cells significantly decreased with increasing BMI. Furthermore, the expression of the immunomodulatory adipokine leptin nicely correlated to the BMI. These effects were stronger in males than in females. Furthermore, the correlation of the activation marker sTNF-R and peripheral T cells strongly decreased with increasing BMI. While IL-6, CD40L, and MPO were significantly induced after surgery, there were no correlations to the BMI.
  
  
  CONCLUSIONS
  The known wound-healing problems in obese patients and the osteoarthritis per se can be linked to the BMI. While obese patients exerted reduced peripheral NK cells and cytotoxic T cells (CTLs), IL-6 showed no involvement. However, the adipokine leptin strongly increased with the BMI strengthening its role as immunomodulatory molecule negatively interfering the functions of immune effector cells.
authors.affiliation: Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany. simon.jasinski@uk-halle.de.
authors.forename: Simon
authors.identifier: http://orcid.org/0000-0001-6300-7371
authors.initials: S
authors.lastname: Jasinski-Bergner
authors.affiliation: Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany.
authors.forename: Anna-Luise
authors.initials: AL
authors.lastname: Radetzki
authors.affiliation: Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Jahn
authors.affiliation: Department for Orthopedics, Trauma and Reconstructive Surgery, University Hospital of Halle (Saale), Halle (Saale), Germany.
authors.forename: David
authors.initials: D
authors.lastname: Wohlrab
authors.affiliation: Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Kielstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D020738:Leptin / Q000097:blood; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000276:immunology*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000276:immunology*; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D014945:Wound Healing / Q000276:immunology*
chemical_list: D020738:Leptin; D018124:Receptors, Tumor Necrosis Factor; D002097:C-Reactive Protein
keywords: Artificial joint implantation; Hip joint; Knee joint; NK cells; Obesity