Acute Phase Reaction, Surgery
Conditions
Brief summary
The primary hypothesis that orthopaedic surgery induces a neuroinflammatory response within 48 hours after elective hip or knee surgery and that there is an association between exaggerated CNS inflammatory response or impaired inflammatory resolution and postoperative cognitive dysfunction within one week and at three months postoperatively.
Detailed description
Patients at 50-85 years of age undergoing orthopedic surgery will be investigated in the perioperative period to detect signs of neuroinflammation using serial CSF and blood sampling for 48 hours in combination with cognitive testing preoperatively, at 3-7 days and after 3 months.
Interventions
None listed
Sponsors
Sahlgrenska University Hospital
Karolinska University Hospital
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
MALE
Age
50 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* ASA Physical Health Class 1-4 * Age 50-85 years * Fluent in Swedish language * Scheduled for primary hip replacement surgery due to arthrosis * MMSE (minimental state test score \>= 25.
Exclusion criteria
* Patient refusal to participate in the trial * Current autoimmune disease, including arthritis * Ongoing smoking, snuff or other nicotine compound treatment * Significant neurologic or psychiatric disorder (such as Alzheimer's disease, Parkinson's disease, Multiple sclerosis, schizophrenia, depression, diagnosis of dementia or cognitive impairment as defined by a preoperative MMSE score ≤ 24 * History of stroke with neurological sequelae. * Current severe cardiac (NYHA\>IV) or renal (plasma creatinine\> 0.250 mmol/l) Coagulopathy making spinal anesthesia and intrathecal catheter placement impossible * Terminal phase of a chronic disease. * Patient on chronic steroidal therapy * Poorly controlled diabetes mellitus. * Presumed uncooperativeness or legal incapacity.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Neuroinflammation measured as IL-6 in CSF | Up to 48 hours postoperatively | IL-6 in CSF |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Peripheral inflammatory response | Up to 48 hours | Cytokines i peripheral blood |
| Neuroinflammation | Up to 48 hours | CNS specific markers in blood |
| Cognitive function | Before surgery, within 7 days after surgery and 3 month after surgery | A cognitive test battery will be applied |
Countries
Sweden
Outcome results
None listed