PERFORMING POSTERIOR SURGICAL ACCESS DURING TOTAL HIP REPLACEMENT IN PATIENTS WITH OSTEOARTHRITIS AND CONCOMITANT CARDIAC PATHOLOGY

Abstract

The aim of our study was to study the severity of operative stress and the assessment of pain status during total hip replacement (THR) using a posterior approach in patients with osteoarthritis and concomitant cardiac pathology. Materials and methods. 35 patients with osteoarthritis of the hip joint and accompanying cardiac pathology, who came to the “Institute of the Heart of the Ministry of Health of Ukraine” for THR, were examined. In all patients, the main biochemical markers of the body’s stress hormonal response were determined, in particular: levels of insulin, cortisol, glucose in the blood serum, which were measured before surgery, as well as, immediately after surgery, 24 hours later, a week after it, at each of these stages the HOMA (Homeostasis model assessment) index was calculated. Results. THR was accompanied by certain dynamics of stress indicators. The intensity of the pain syndrome, measured by the VAS, reached its peak one day after the operation, on the 7th day it significantly decreased, but the pain did not disappear. The index of insulin resistance, the HOMA index, which in a certain way reflects the intensity of stress reactions, increased significantly after surgery, did not change significantly, and on the 7th day almost returned to the initial level (p = 0.085). The cortisol level changed reliably throughout the study. After the operation, it increased, then decreased. On the 7th day after surgery, cortisolemia became significantly lower than the initial level. Conclusions. Performing posterior surgical access during THR in patients with osteoarthritis and concomitant cardiac pathology causes changes in the intensity of stressor reactions.