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Total knee replacement surgery is followed by transitory endothelial dysfunction
Kresimir Bukal1, Alen Ruzić, Ksenija Bazdarić
1Lovran Clinic for Orthopaedic Surgery, Lovran, Croatia.
Insights
Major orthopedic surgery temporarily worsens endothelial dysfunction (ED), a key factor in cardiovascular complications. This study tracked ED after knee replacement, finding a dip 24 hours post-op. Further research is needed to link this ED to adverse events.
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.
Abstract:
Acute coronary syndrome (ACS) presents today the leading group of post-operative cardiovascular complications, while endothelial dysfunction (ED) is one of the key elements in its development. The chronic ED represents thus the basis for the gradual development of atherosclerotic changes, while its sudden aggravation leads to ACS. The persistent ED occurs due to the effects of chronic cardiovascular risk factors, while according to the available studies it can also develop or aggravate under the impact of different acute events. We have directed this study to the investigation of the dynamic of endothelial function before and after a major orthopaedic surgical intervention. This randomised prospective study included 19 patients that underwent the intervention of total knee replacement and 20 healthy examinees of the adequate age and gender High-resolution ultrasound test based on the flow mediated dilatation of the brachial artery is what at we carried out at the beginning of the research, respectively 12, 24, 48 and 72 hours, as well as 7 days after the surgical intervention. The starting values of the FMD test were within the normal range in both groups, although the ability of dilatation upon stimulus was significantly lower in the investigated group. The FMD percentage change in the total sample was negatively connected with the body weight, not having shown additional connections with other cardiovascular risk factors. During the early post-operative period, a significant transitory lowering of the FMD percentage change was recorded, having reached the lowest value 24 hours after the surgery. During the seven-day prospective surveillance, no significant cardiovascular complications were recorded. Further research is necessary in order to confirm these results as well as the testing of the possible connection of the described post-operative transitory endothelial dysfunction with the development of cardiovascular complications and the adverse event.
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