ABSTRACT
BACKGROUND: Air tourniquet-induced skeletal muscle injury increases the concentrations of some cytokines such as interleukin-6 (IL-6) in plasma. However, the effect of an air tourniquet on the IL-6 concentrations after total knee arthroplasty (TKA) is unclear. We therefore investigated the impact of tourniquet-induced ischemia and reperfusion injury in TKA using the IL-6 level as an index. METHODS: Ten patients with primary knee osteoarthrosis who underwent unilateral TKA without an air tourniquet were recruited (Non-tourniquet group). We also selected 10 age- and sex-matched control patients who underwent unilateral TKA with an air tourniquet (Tourniquet group). Venous blood samples were obtained at 3 points; before surgery, 24 h after surgery, and 7 days after surgery. The following factors were compared between the two groups; IL-6, C-reactive protein (CRP), creatine phosphokinase (CPK), the mean white blood cell (WBC) counts, and the maximum daily body temperatures. RESULTS: The IL-6 level at 24 h after surgery was significantly higher than that at any other point (p<0.01). No significant differences were observed in the WBC count, the body temperature, or the CRP, CPK, or IL-6 levels of the two groups at any of the time points. CONCLUSION: The effect of ischemia and reperfusion due to the use of an air tourniquet on increasing the IL-6 level was much smaller than that induced by surgical stress in TKA.
ABSTRACT
BACKGROUND: Surgical stress is known to affect body temperature, white blood cell (WBC) count, C-reactive protein (CRP), and interleukin-6 (IL-6). The aim of the present study was to investigate which parameter is most suitable for quantitative analysis of surgical stress. METHODS: Unilateral total knee arthroplasty (U-TKA) and bilateral TKA (B-TKA) were selected for the subjects of this study because the B-TKA creates approximately double the surgical stress of the U-TKA. The temperature, WBC count, CRP, and IL-6 in the blood were measured pre- and postoperatively in both groups. The IL-6 in the drainage fluid was also measured after the operation. RESULTS: The temperature, WBC count, CRP, and IL-6 in the blood significantly increased on the first day after the operation in both groups. There were significant differences between the two groups in the WBC count (P < 0.05) and the IL-6 level in the blood (P < 0.05) on the first day after the surgery. There were no significant differences between the two groups for the CRP and IL-6 levels in the drainage fluid. The relative proportions--(B-TKA/U-TKA) x 100 (%)--were 170.4% for the operating time, 219.4 % for total blood loss, 200.0% for blood transfusion, 100.3% for temperature, 128.9% for WBC count, 127.4% for CRP, and 246.5% for the IL-6 level in the blood. CONCLUSIONS: The serum IL-6 level may best reflect surgical stress and could therefore be a quantitative marker of surgical stress.
Subject(s)
Arthroplasty, Replacement, Knee/methods , C-Reactive Protein/analysis , Interleukin-6/blood , Osteoarthritis, Knee/surgery , Aged , Arthroplasty, Replacement, Knee/adverse effects , Biomarkers/blood , Cohort Studies , Female , Follow-Up Studies , Humans , Leukocyte Count , Osteoarthritis, Knee/blood , Postoperative Care , Postoperative Complications/blood , Postoperative Complications/diagnosis , Probability , Risk Factors , Sensitivity and Specificity , Stress, PhysiologicalABSTRACT
The present study was conducted to investigate burden among caregivers of patients with osteoarthritis of hip joint. Caregivers and their elderly patients with osteoarthritis of hip joint were compared with caregivers and their frail elderly who received regular nurse visits or caregivers and their non-demented frail elderly with regular nurse visits. The patients with osteoarthritis of hip joint had less disability to perform ADL than the frail elderly with regular nurse visits. The caregivers of the patients spent less time on both caregiving and attending patients, and showed the shorter duration of caregiving than those of the frail elderly with regular nurse visits. They were less likely to consult with physicians for their own health and less likely to become ill health, and felt less burden than the caregivers of the frail elderly with regular nurse visits although they used less kinds of social services than their controls. Since none of patients with osteoarthritis of hip joint suffered from dementia, the non-demented frail elderly with regular nurse visits were used as another control. But the results did not changed. These finding suggest that caregivers of less disability to perform ADL may feel light burden when the patients do not suffer from dementia.
