Chronic Endotoxemia and Peculiarities of Systemic Inflammatory Response in Patients with Osteoarthrosis Requiring Primary Arthroplasty of Large Joints

INTRODUCTION: Infectious complications after the primary arthroplasty of large joints in patients with end-stage osteoarthrosis are often associated with self-opportunistic pathogenic microflora in cases of compromised immune response and systemic inflammatory reactions. Thus, the associated pathogenic mechanisms require additional study.

AIM: To examine the peculiarities of signs of endotoxemia and the severity of the systemic inflammatory response (SIR) in patients with osteoarthritis of large joints requiring primary arthroplasty.

MATERIALS AND METHODS: A total of 110 patients (67 women, 43 men, average age 49.2 years, age range 41.1–52.8 years) with stage III–IV primary osteoarthrosis of the knee joints and 30 healthy individuals (control group) (15 men, 15 women, average age 49.4 years, age range 37.2–53.1 years) were examined. Analyses were carried out on blood serum concentrations of the endotoxemia parameter lipopolysaccharide (LPS), acute-phase proteins (C-reactive protein [CRP]), lipopolysaccharide-binding protein (LBP), and markers of the proinflammatory activity of cytokine regulation system (interleukine-1β [Il-1β]) and activation of cell-mediated immunity (neopterin). Correlation relationships between the studied parameters were evaluated depending on the severity of the SIR.

RESULTS: Forty patients were identified (28 women, 12 men) to have signs of high inflammatory activity (CRP concentration ≥ 7.59 g/L and erythrocyte sedimentation rate ≥ 10 mm/h) and evident synovitis based on the ultrasound data of the joint. The parameters in this group were analyzed: LPS, 12.08 (10.77; 12.65) ng/mL; LBP, 26.31 (25.48; 27. 11) µg/mL; Il-1β, 8.4 (7.3; 8.7) pg/mL; and neopterin, 9.36 (8.58; 9.62) pg/mL. These values significantly (р < 0.05, Kruskal–Wallis test) exceeded the values in the moderate SIR activity and control groups. Correlation analysis (Spearman r-test) in patients with signs of enhanced inflammatory activity revealed a moderate positive relationship between LPS and CRP concentrations, and reduction of positive relationships between LPS and Il-1β and in LPS and LBP.

CONCLUSION: Impaired SIR with the underlying excessive proinflammatory activity of the cytokine regulation system, activation of the cell-mediated immunity, and systemic endotoxemia in patients with end-stage osteoarthrosis of large joints requires additional preoperative and postoperative monitoring. The results substantiate the necessity of a detailed investigation of endotoxemia as a probable component of the pathogenesis and sanogenesis of complications following the primary arthroplasty of large joints.