Laboratory possibilities of prognosis of local complications in hip replacement

BACKGROUND: Endoprosthetics of large joints is a frequently performed operation in traumatology practice. The progression of local infectious sequela among postoperative patients is of major socio-economic importance since more than 30% of cases of inflammatory postoperative reactions are complicated by sepsis. In recent years, new criteria have been sought to assess the risks of infection in the field of surgical intervention, and prognostic scales have also been developed.

AIM: The aim of the study was to evaluate the prognostic value of coagulological, biochemical and hematological indicators of the risk of hemorrhagic complications in patients after hip replacement.

MATERIALS AND METHODS: The study included 85 patients who were in the clinic of Traumatology and Orthopedics of the I.I. Mechnikov for planned hip replacement. The average age of the patients was 64 ± 10 years. There were 46 women (54%), 39 men (46%). All patients underwent clinical and laboratory examination before surgery, the day after surgery and before discharge. All patients received rivaroxaban (10 mg 1 time/day) after surgery for the prevention of venous thromboembolic complications (46 patients) or apixaban (2.5 mg 2 times/day) (39 patients) during the entire period of stay in the clinic. Retrospectively, depending on the occurrence of complications, the patients were divided into 2 groups: group 1 — 78 patients (42 women and 36 men), whose postoperative period passed without complications, and group 2 — 7 patients (4 women and 3 men), who had hemorrhagic cases. Screening coagulogram (International Normalized Ratio, Activated partial thromboplastin time, fibrinogen) was performed on the STA Compact analyzer (Stago, France), biochemical parameters (alanine aminotransferase, aspartate aminotransferase, creatinine, total calcium, ionized calcium, serum iron, C-reactive protein) were determined on the COBAS Integra 400plus analyzer, hematological parameters on the DxH800 analyzer (Beckman Coulter, USA).

RESULTS: A retrospective analysis revealed that a decrease in serum iron in male patients before surgery is a marker of the prognosis of hemorrhagic complications. Prognostic significant laboratory indicators of the development of hemorrhagic complications in patients in the early period after hip replacement include an increase in fibrinogen and C-reactive protein; a decrease in serum iron. During the recovery period, the concentration of C-reactive protein and the relative number of monocytes are the most significant for assessing the risk of complications.

CONCLUSIONS: Among the laboratory indicators in the structure of the weight coefficients of the prognosis of complications in patients undergoing hip replacement, it is necessary to evaluate the concentration of serum iron before surgery, especially in men, in the early postoperative period — C-reactive protein, fibrinogen and serum iron and at discharge — C-reactive protein and the number of monocytes as additional criteria for the risk of complications.