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British Journal of Anaesthesia, 2001, Vol. 87, No. 4 537-542
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses{dagger}

G. M. Hall1, D. Peerbhoy2, A. Shenkin3, C. J. R. Parker4 and P. Salmon2

1Department of Anaesthesia and Intensive Care Medicine, St George’s Hospital Medical School, London SW17 0RE, UK. 2Department of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK. 3Department of Clinical Chemistry, University of Liverpool, Duncan Building, Daulby Street, Liverpool L69 3GA, UK. 4Department of Anaesthesia, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK*Corresponding author

We studied the relationship between the neuroendocrine and inflammatory responses to hip arthroplasty and functional recovery in 102 patients undergoing elective arthroplasty for osteoarthritis. Blood samples were collected for up to 7 days after surgery and analysed for concentrations of norepinephrine, epinephrine, cortisol, interleukin-6 and C-reactive protein. The primary outcome measures were milestones in hospital, times to walk 10 and 25 m, pain on discharge from hospital, and function 1 and 6 months after surgery. Walking distances in hospital were significantly delayed in patients with greater interleukin 6 and C-reactive protein concentrations, but few neuroendocrine measures had significant correlations with functional recovery in hospital. Multivariate analysis showed that the interleukin 6 concentration on day 1 was the unique predictor of time to walk 10 and 25 m, and that the day 2 concentration of C-reactive protein was the unique predictor of pain on discharge from hospital. No significant correlations were found between the inflammatory and neuroendocrine variables and recovery at 1 and 6 months. We conclude that the inflammatory response affects immediate functional recovery after hip arthroplasty.

Br J Anaesth 2001; 87: 537–42


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