scholarly journals Urinary neopterin and total neopterin measurements allow monitoring of oxidative stress and inflammation levels of knee and hip arthroplasty patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256072
Author(s):  
Gregory Baxter-Parker ◽  
Lloyd Roffe ◽  
Elena Moltchanova ◽  
Jay Jefferies ◽  
Siddarth Raajasekar ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Group Versus ◽  
Hip Osteoarthritis ◽  
The Body ◽  
Urinary Neopterin ◽  
Knee And Hip Arthroplasty ◽  
Arthroplasty Surgery ◽  
Biomarkers Of Oxidative Stress

Knee and hip arthroplasty are common surgeries within an aging population. Some data has suggested that knee arthroplasty is more traumatic to the body than hip arthroplasty due to the increased complexity and load bearing nature of the joint. Here, we compare the stress of the two surgeries by measuring urinary neopterin and total neopterin as biomarkers of oxidative stress and inflammation. Urinary neopterin and total neopterin (neopterin + 7,8-dihydroneopterin) levels were analysed in 28 knee and 22 hip arthroplasty patients pre- and post-operatively to determine oxidative stress and inflammation levels. Total neopterin was 31.1% higher with knee arthroplasty (p<0.05). Urinary neopterin was 32.8% higher in the knee arthroplasty group versus hips. The increase in neopterin and total neopterin following a post-surgical decrease in levels was significant in both groups. Levels of neopterin and total neopterin were varied between patients, but all increased following surgery and subsided by day 28. The increased levels of urinary neopterin and total neopterin from knee arthroplasty indicate that knee osteoarthritis and arthroplasty is a more significant trauma to the body than hip osteoarthritis and arthroplasty surgery. This is also shown by faster inflammatory resolution following hip arthroplasty.

scholarly journals Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

2020 ◽  
Vol 27 (1) ◽  
pp. 31-35
Author(s):  
K. Yu. Ukolov ◽  
V. L. Ayzenberg ◽  
M. V. Kapirina ◽  
M. E. Mikitina
Keyword(s):  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Postoperative Nausea And Vomiting ◽  
Anaesthetic Agents ◽  
Group I ◽  
Primary Knee Arthroplasty ◽  
Group Ii ◽  
Knee And Hip Arthroplasty

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic. Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement. Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups. Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups. Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

Local infiltration analgesia in knee and hip arthroplasty efficacy and safety

2016 ◽  
Vol 13 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Fatin Affas
Keyword(s):  
Total Knee Arthroplasty ◽  
Plasma Concentration ◽  
Pain Relief ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Total Knee ◽  
Knee And Hip Arthroplasty ◽  
Infiltration Analgesia

AbstractBackgroundThis is a secondary publication of a PhD thesis. Local infiltration analgesia (LIA) is a new multimodal wound infiltration method for treating postoperative pain after knee and hip arthroplasty. This method is based on systematic infiltration of a mixture of ropivacaine, a long acting local anaesthetic, ketorolac, a cyclooxygenase inhibitor (NSAID), and adrenalin around all structures subject to surgical trauma in knee and hip arthroplasty.AimsPaper I: to assess whether pain relief after LIA in total knee arthroplasty (TKA) is as effective as femoral block. Paper II: to assess whether the plasma concentration of ropivacaine and ketorolac after LIA in TKA reaches levels linked to toxicity. Paper III: to assess whether the plasma concentration of unbound ropivacaine after LIA in THA reaches levels linked to toxicity and if it is higher in THA as compared to TKA. Paper IV: to assess whether the plasma concentration of ketorolac after LIA in THA reaches levels linked to toxicity, and whether administration of ketorolac in LIA is safer as compared to the intramuscular route.MethodsTwo patient cohorts of 40 patients scheduled for elective total knee arthroplasty (TKA) and 15 patients scheduled for total hip arthroplasty (THA) contributed to this work. In a randomized trial the efficacy of LIA in TKA with regard to pain at rest and upon movement was compared to femoral block.ResultsBoth methods result in a high quality pain relief and similar morphine consumption during the 24 h monitoring period. In the same patient cohort the maximal total plasma concentration of ropivacaine was below the established toxic threshold for most patients. All patients in the THA cohort were subjected to the routine LIA protocol. In these patients both the total and unbound plasma concentration of ropivacaine was determined. The concentration was below the established toxic threshold. As ropivacaine binds to α–1 acid glycoprotein (AAG) we assessed the possibility that increased AAG may decrease the unbound concentration of ropivacaine. A 40% increase in AAG was detected during the first 24 h after surgery, however the fraction of unbound ropivacaine remained the same. There was a trend towards increased Cmax of ropivacaine with increasing age and decreasing creatinine clearance but the statistical power was too low to draw any conclusion. Administration of 30 mg ketorolac according to the LIA protocol both in TKA and THA resulted in a similar Cmax as previously reported after 10 mg intramuscular ketorolac. Neither age, nor body weight or BMI, nor creatinine clearance, correlates to maximal ketorolac plasma concentration or total exposure to ketorolac (AUC).ConclusionLIA provides good postoperative analgesia which is similar to femoral block after total knee arthroplasty. The plasma concentration of ropivacaine seems to be below toxic levels in most TKA patients. The unbound plasma concentration of ropivacaine in THA seems to be below the toxic level.ImplicationThe use of ketorolac in LIA may not be safer than other routes of administration, and similar restrictions should be applied in patients at risk of developing side effects.

scholarly journals Variation in Outcome Measures in Hip and Knee Arthroplasty Clinical Trials: A Proposed Approach to Achieving Consensus

2009 ◽  
Vol 36 (9) ◽  
pp. 2050-2056 ◽  
Author(s):  
DANIEL L. RIDDLE ◽  
PAUL W. STRATFORD ◽  
JASVINDER A. SINGH ◽  
C. VIBEKE STRAND
Keyword(s):  
Clinical Trials ◽  
Outcome Measures ◽  
Knee Arthroplasty ◽  
Randomized Trials ◽  
Survey Design ◽  
Hip Osteoarthritis ◽  
Optimal Outcome ◽  
The Past ◽  
Hip And Knee Arthroplasty ◽  
Knee And Hip Arthroplasty

OMERACT began work over a decade ago on a consensus effort to identify optimal outcome measures for knee and hip osteoarthritis clinical trials. Recent evidence indicates extensive variation in outcome measures used in clinical trials of knee and hip arthroplasty published since 2000. This heterogeneity leads to confusion, not only for conducting systematic reviews but also for applying evidence to clinical practice. Given the extensive psychometric research conducted in the past 2 decades, the timing seems ideal to design and implement a study to develop consensus on optimal outcome measures for hip and knee arthroplasty trials. We describe a Delphi survey design and an approach for synthesizing the extensive psychometric literature on the outcome measures used in hip and knee arthroplasty trials. Plans for dissemination of the findings are also discussed. This proposed study could have an important influence on the design and reporting of future randomized trials of knee arthroplasty.

scholarly journals Patients Undergoing Surgery for Hip Fractures Suffer from Severe Oxidative Stress as Compared to Patients with Hip Osteoarthritis Undergoing Total Hip Arthroplasty

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Theofilos Karachalios ◽  
Dionyssios Paridis ◽  
Fotios Tekos ◽  
Zoi Skaperda ◽  
Aristidis S. Veskoukis ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Total Hip Arthroplasty ◽  
Bone Turnover ◽  
Antioxidant Capacity ◽  
Hip Fractures ◽  
Hip Arthroplasty ◽  
Hip Osteoarthritis ◽  
First Line ◽  
Blood Samples ◽  
Oxidative Defense

Hip fractures are associated with the highest degree of morbidity and mortality of all fractures in elderly patients and pose a major risk for subsequent fractures. Patients with hip fractures also present accelerated bone turnover despite early stable fracture fixation and early mobilization. We aimed to evaluate oxidative stress in two groups of patients (25 patients each, matched for age, side, and BMI) who underwent internal fixation of hip fractures and total hip arthroplasty for hip osteoarthritis. Blood samples were taken from all patients during admission, the day of surgery, the 4th postoperative day, and the 15th postoperative day. Reduced (GSH) and oxidized (GSSG) glutathione, GSH/GSSG, catalase (CAT), thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), and total antioxidant capacity (TAC) as a widely used battery of redox biomarkers were recorded from blood samples. Patients with hip fractures who undergo fixation surgery, compared to those with hip osteoarthritis, suffer significant oxidative stress with an active but insufficient first line of oxidative defense, an intensive first line reaction, a very active second line of oxidative defense, and a low plasma antioxidant capacity. Surgery worsened already present lipid- and protein-related tissue damage. The severe oxidative stress observed may explain high morbidity and mortality rates and high bone turnover status, as well as the high incidence of refractures. Furthermore, the question of whether antioxidant therapy measures should be introduced in the management of hip fracture patients is raised.

scholarly journals Is the Oxidative Stress Really a Disease?

2016 ◽  
Vol 62 (1) ◽  
pp. 112-120 ◽  
Author(s):  
Erzsébet Fogarasi ◽  
Mircea Dumitru Croitoru ◽  
Ibolya Fülöp ◽  
Daniela-Lucia Muntean
Keyword(s):  
Oxidative Stress ◽  
Free Radical ◽  
The Body ◽  
Myeloperoxidase Activity ◽  
Stress Markers ◽  
Tyrosine Derivatives ◽  
Radical Generation ◽  
Endogenous Antioxidant ◽  
Derivatives Of ◽  
Biomarkers Of Oxidative Stress

AbstractOxidative stress is an imbalance between free radicals or other reactive species and the antioxidant activity of the organism. Oxidative stress can induce several illnesses such as cardiovascular disease, neurodegenerative disorders, diabetes, cancer, Alzheimer and Parkinson. The biomarkers of oxidative stress are used to test oxidative injury of biomolecules. The indicators of lipid peroxidation (malondialdehyde, 4-hydroxy- 2-nonenal, 2-propenal, isoprostanes), of protein oxidation (carbonylated proteins, tyrosine derivatives), of oxidative damage of DNA, and other biomarkers (glutathione level, metallothioneins, myeloperoxidase activity) are the most used oxidative stress markers. Diseases caused by oxidative stress can be prevented with antioxidants. In human body are several enzymes with antioxidant capacity (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase) and spin traps. Antioxidants are synthetized in the organism (glutathione) or arrive in the body by nutrition (ascorbic acid, vitamin E, carotenoids, flavonoids, resveratrol, xanthones). Different therapeutic strategies to reduce oxidative stress with the use of synthetic molecules such as nitrone-based antioxidants (phenyl-α-tert-butyl-nitrone (PBN), 2,4-disulphophenyl- N-tert-butylnitrone (NXY-059), stilbazulenyl nitrone (STAZN), which scavenge a wide variety of free radical species, increase endogenous antioxidant levels and inhibits free radical generation are also tested in animal models.

scholarly journals Blood Salvage in Total Hip and Knee Arthroplasty in a Community Hospital: A Retrospective Study

2005 ◽  
Vol 13 (1) ◽  
pp. 19-26 ◽  
Author(s):  
R Jain ◽  
S Jain
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Allogeneic Blood Transfusion ◽  
Allogeneic Blood ◽  
Blood Salvage ◽  
Total Hip ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

Purposes: To assess the results of postoperative and intra-operative blood salvage in patients undergoing total knee and hip arthroplasty, respectively, and to determine if both methods of blood salvage reduce allogeneic transfusion. Methods: Of 229 patients who attempted blood salvage, 114 of 152 patients who underwent total knee arthroplasty received the salvaged blood postoperatively, 35 of 77 patients who underwent total hip arthroplasty received the salvaged blood intra-operatively. Various data were collected to assess whether certain factors resulted in autologous and/or allogeneic blood transfusions. Results: Patients that received postoperative salvaged blood after total knee arthroplasty generally had higher postoperative levels of haemoglobin and haematocrit compared to those who did not. Patients with autologous blood transfusion following cemented knee surgery were less likely to require allogeneic blood transfusion. For hip arthroplasty patients, postoperative levels of haemoglobin and haematocrit were similar in both groups who received and did not receive salvaged blood. Lower preoperative haemoglobin and haematocrit levels correlated with a greater likelihood of autologous and/or allogeneic blood transfusion for both knee and hip arthroplasty patients. Conclusions: Although total knee arthroplasty patients who received salvaged blood had higher haemoglobin levels on the first postoperative day, the receipt of salvaged blood did not significantly reduce the incidence of allogeneic blood transfusion, because salvaged blood was a kind of blood loss. However, reinfusion of salvaged blood may reduce the number of units of allogeneic blood used. Given the short supply of allogeneic blood and its risks of transmitting disease, intra-operative and postoperative blood salvage carries clear advantages.

scholarly journals Oxidative profile of patients with osteoarthrosis undergoing total knee arthroplasty

2014 ◽  
Vol 27 (2) ◽  
pp. 165-171
Author(s):  
Bruna Pierezan ◽  
Bruna Webber ◽  
Marlon Francys Vidmar ◽  
César Antônio de Quadros Martins ◽  
Carlos Rafael de Almeida ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
The Body ◽  
Osteoarthritis Of The Knee ◽  
Antioxidative Defense ◽  
Oxidative Stress Markers ◽  
Defense Systems ◽  
Stress Markers ◽  
Total Knee

Introduction Total knee arthroplasty may be the most appropriate method of treatment in several cases of osteoarthritis. This disease causes tissue damage, which is closely related to the production of free radicals, leading to oxidative stress and to lipid damage. Because of that, the body has several antioxidative defense systems involved in detoxification (antioxidants).Objective Based on the previous information, the goal of this study was to establish the systemic and local oxidative profile of individuals with osteoarthritis submitted to total knee arthroplasty.Materials and methods The sample consisted of four female patients (65.5 ± 0.7 years) with osteoarthritis of the knee. Blood and synovial fluid (SF) samples were collected from the patients 15 minutes before surgery. The concentrations of flavonoids, catalase, and TBARS were then quantified.Results The results indicate a higher catalase activity in the SF than in the serum (S), (SF = 1 S = 14.3 ± 3.1 ± 0.8). The concentration of TBARS proved to be higher in the SF (SF = 0.29 ± 0.02 S = 0.09 ± 0.05), whereas the concentration of phenols was higher in the serum (SF = 3.2 S = 5.2 ± 0.2 ± 0.6).Conclusion Osteoarthritis is a disease that increases the oxidative stress markers in the serum and in the SF.

Sign in / Sign up

Export Citation Format

Share Document