Korelacija intramedularnega tlaka in sistemskih vnetnih parametrov pri cementiranih in brez cementnih steblih endoprotez pri artroplastiki kolka

Ukaj, Skender (author), Cimerman, Matej (mentor)

Cilj: Namen te študije je bil ovrednotiti korelacijo spremenjenega intramedularnega tlaka z drugimi sistemskimi vnetnimi parametri med cementirano in necementirano totalno artroplastiko kolka. Metode: Prospektivna študija 60 bolnikov je bila izvedena v UKCK in bolnišnici Otrila. Povprečna starost bolnikov je bila 72,17 (±6,02) in 75,5 (±7,40) leta, cementirana in necementirana, oziroma totalno artroplastiko kolka., in te razlike niso bile statistično značilne (t (58) = -1,913, p=0,061). Šestmesečna študija je vključevala 33 žensk (55 %) in 27 moških (45 %), razdeljenih v dve enaki skupini po 30 bolnikov (17 žensk in 13 moških), zdravljenih s cementom, in 30 bolnikov (16 žensk in 14 moških) z necementiranim totalno artroplastiko kolka. Izmerili smo intramedularni tlak znotraj kosti z uporabo pretvornika tlaka z 10-bitnim modulom ADC, s 1024 odčitki za meritve v polnem obsegu. Sistemske vnetne parametre (histamin, IL1b, IL6, TNF, CRP, ESR) smo analizirali pred in po kirurških posegih v korelaciji s spremenjenim intramedularnim tlakom po totalni artroplastiki kolka. Rezultati: Povprečna starost bolnikov s cementno ali necementirano totalno artroplastiko kolka ni bila značilna (72,17 (±6,02) v primerjavi s 75,5 (±7,40); (t (58) = -1,913, p=0,061). Povprečni tlak pri bolnikih brez cementa je bila 146,23 (±73,96) mmHg, medtem ko je bila pri tistih s cementom 1052 (±275,67) mmHg. Med sistematičnimi vnetnimi parametri je bilo pet parametrov pomembnih v vsaki od obeh študijskih skupin, cement v primerjavi s totalno artroplastiko kolka brez cementa; histamin ( 5,99 proti 0,854), p < 0,0001, IL6 (275,00 proti 152,00), p = 0,004, TNF alfa F (1, 5 proti 210,57), p < 0,0001, ESR F (1, 56 proti 18,83), p < 0,0001, CRP F (1, 56 proti 7,59), p < 0,01, medtem ko le en parameter IL1b ni bil pomemben F (1, 56 proti 3,496), p = 0,067. Zaključki: Intramedularni tlak se je znatno povečal med implantacijo femoralne komponente in po totalni artroplastiki kolka. Ugotavljamo tudi močno korelacijo med povečanim IMP po cementirani totalno artroplastiko kolka in večino sistemskih vnetnih parametrov, kot so histamin, IL6, TNF alfa, ESR, CRP. Ti rezultati tudi kažejo, ali bi prišlo do pooperativnih zapletov, povezanih s kolčnimi protezami s cementnimi ali necementiranimi komponentami, in bi lahko pozitivno vplivali na postopke zdravljenja bolnikov in boljše rezultate

• Language: Slovenian
• Keywords: implantacija kolčne proteze, kostni cement, perioperativno obdobje
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2023
• PID: 20.500.12556/RUL-144478
• COBISS.SI-ID: 147037955
• Publication date in RUL: 24.02.2023

Secondary language

• Language: English
• Title: Correlation of intramedullary pressure on systemic inflammatory parameters in the cemented and non-cemented femoral stem of the hip arthroplasty

Abstract

Objective: The aim of this study was to evaluate the correlation of altered intramedullary pressure with other systemic inflammatory parameters during cemented and uncemented total hip arthroplasty. Methods: A prospective study of 60 patients was performed at UCCK and Otrila Hospital. The mean age of the patients was 72.17 (±6.02) and 75.5 (±7.40) years, cemented and uncemented, respectively THA, and these differences were not statistically significant (t (58) = -1.913, p=0.061). The six-month study included 33 women (55%) and 27 men (45%), divided into two equal groups of 30 patients (17 women and 13 men) treated with cement and 30 patients (16 women and 14 men) with uncemented THA. We measured intramedullary pressure within the bone using a pressure transducer with a 10-bit module ADC, with 1024 readings for full-scale measurements. Systemic inflammatory parameters (histamine, IL1b, IL6, TNF, CRP, ESR) were analyzed before and after the surgical procedures in correlation with the altered intramedullary pressure after total hip arthroplasty. Results: The mean age of patients with cemented or non-cemented THA was not significant (72.17 (±6.02) vs. 75.5 (±7.40); (t (58) = -1.913, p=0.061). Mean pressure in patients without cement was 146.23 (±73.96) mmHg, while in those with cement it was 1052 (±275.67) mmHg. Among the systematic inflammatory parameters, five parameters were significant in each of the two study groups, cement vs. without cement THA; histamine (5.99 vs. 0.854), p < 0.0001, IL6 (275.00 vs.152.00), p = 0.004, TNF alfa F (1, 5 vs. 210.57), p < 0.0001, ESR F (1, 56 vs. 18.83), p < 0.0001, CRP F (1, 56 vs. 7.59), p < 0.01, while only one parameter IL1b was not significant F (1, 56 vs. 3.496), p = 0.067. Conclusions: Intramedullary pressure increased significantly during femoral component implantation and after total hip arthroplasty. We also conclude a strong correlation between increased IMP after cemented THA and the majority of systemic inflammatory parameters, such as histamine, IL6, TNF alfa, ESR, CRP. These results also indicate whether there would be postoperative complications associated with hip prostheses with cemented or non-cemented components, and could have a positive impact on patient treatment procedures and better outcomes.

• Keywords: Hip Prosthesis Implantation, Bone Cement, Perioperative period