Tension of stress responses in patients with osteoarthritis and concomitant cardiac pathology during hip joint replacement surgery

Abstract

Background. Total hip arthroplasty (THA) is one of the safest and most effective orthopaedic surgeries, but it carries a significant risk of complications, particularly in patients with concomitant cardiac pathology. Therefore, choosing the optimal type of surgical approach is crucial for these patients. The study purposed to compare the intensity of stress reactions in the perioperative period and assess hip joint functioning in patients with osteoarthritis and concomitant cardiac pathology undergoing THA, depending on the type of surgical approach. Materials and methods. This study analyzed the treatment outcomes in 90 patients with hip osteoarthritis and cardiac pathology who underwent total cement hip arthroplasty. All patients were divided into two groups based on the surgical approach: traditional posterior (35 patients, group 1) and modified posterior (MPA) (55 patients, group 2). Serum levels of insulin, cortisol, glucose, IL-6, and TNF-α were measured before surgery, immediately after it, 24 hours later, and one week after surgery. At each stage, the homeostasis model assessment (HOMA) index was calculated, and pain status was assessed using the visual analogue scale. Hip joint functioning was evaluated with the Harris scale before surgery, one week, and one month after it. Results. The MPA significantly reduced postoperative pain, most notably immediately after surgery (stage 2). Throughout the study, pain intensity remained significantly lower in the MPA group. The HOMA index was initially similar in both groups, but it was significantly lower in the MPA group immediately after surgery and on the first postoperative day. By the seventh postoperative day, the HOMA index difference approached significance (p = 0.08), remaining lower in group 2. Cortisol levels showed similar dynamics. IL-6 and TNF-α concentrations did not differ between groups during the first three stages but were significantly lower in the MPA group on the seventh postoperative day. Hip function was comparable in both groups one week post-surgery but was significantly better in the MPA group after one month. Conclusions. The modified posterior approach offers significant advantages over the traditional approach in THA for patients with osteoarthritis and concomitant cardiac pathology.