Systemic and local cytokine patterns during total hip surgery

Objective. Increased levels of inflammatory cytokines have been described in musculoskeletal injury. Total hip replacement is major musculoskeletal surgery, and in the present study this operation was used to investigate systemic and local cytokine patterns during musculoskeletal trauma. Material and methods. Blood was sampled before, during and after surgery in 10 patients given total hip replacement. Samples of arterial blood and local blood from the femoral canal were analysed for proinflammatory and anti-inflammatory cytokines. Results. Surgery induced significant increases in arterial and local levels of interleukin 6 (IL- 6) ( p = 0.000, respectively) with the highest levels at 4 h after operation. There were significantly higher local levels of IL- 6 than arterial levels. Interleukin 1 beta ( IL- 1b) was not significantly influenced by surgery at any time ( p = 0.800 and 0.300 for local and arterial levels, respectively), nor was tumour necrosis factor ( TNF alpha) ( p = 0.375 and 0.547 for local and arterial levels, respectively). Local levels were higher than arterial levels for IL- 1b and for TNFa. At the end of the operation, local levels of interleukin 10 ( IL- 10) were significantly reduced ( p = 0.036), while surgery did not influence the arterial levels of IL- 10 ( p = 0.235). There were no significant differences in local and arterial levels of IL- 10 ( p = 0.558). Conclusions. The study indicates that a major musculoskeletal operation on otherwise healthy patients is associated with fairly modest reactions of inflammation, both systemically and locally.