Total knee replacement surgery is followed by transitory endothelial dysfunction

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Orthopedic Surgery

Background:

• Endothelial dysfunction (ED) is central to acute coronary syndrome (ACS) and atherosclerotic changes.
• ED can be chronic, driven by risk factors, or acute, triggered by events.
• Post-operative cardiovascular complications, including ACS, are a significant concern after major surgery.

Purpose of the Study:

• To investigate the dynamic changes in endothelial function before and after major orthopedic surgery.
• To assess the impact of total knee replacement on endothelial function.
• To explore the relationship between endothelial function and cardiovascular risk factors in the post-operative period.

Main Methods:

• A randomized prospective study involving 19 patients undergoing total knee replacement and 20 healthy controls.
• High-resolution ultrasound measurement of flow-mediated dilation (FMD) of the brachial artery.
• Serial FMD measurements were taken pre-operatively and at 12, 24, 48, 72 hours, and 7 days post-surgery.

Main Results:

• Baseline FMD was within normal limits, but the ability to dilate was significantly lower in the surgical group.
• A significant, transient decrease in FMD was observed in the early post-operative period, reaching its lowest point 24 hours after surgery.
• The FMD percentage change was negatively correlated with body weight; no other cardiovascular risk factor correlations were found.
• No significant cardiovascular complications occurred during the seven-day follow-up period.

Conclusions:

• Major orthopedic surgery, such as total knee replacement, induces a temporary decline in endothelial function.
• This post-operative endothelial dysfunction may be a transient phenomenon, but its potential link to future cardiovascular complications warrants further investigation.
• Additional research is necessary to confirm these findings and elucidate the clinical significance of post-operative ED.