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Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

  • Symposium: Perioperative Pain Management in Orthopaedic Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The prevalence of obesity is increasing, and obesity often leads to degenerative joint disease requiring total hip arthroplasty (THA). Obesity is a proinflammatory state associated with an increase in chronic, low-grade inflammatory response. As such, it may augment the postoperative inflammatory response, which has been associated with postoperative pain and complications.

Questions/purposes

We determined whether severity of obesity was associated with (1) severity of inflammatory response, as measured by the in vivo circulating levels of cytokines and ex vivo functional reactivity of mononuclear blood cells, and (2) severity of pain, as measured by verbal pain scores and analgesic consumption, in the first 24 hours after THA.

Methods

We studied 60 patients (20 normal weight, 20 overweight, 20 obese) undergoing elective primary unilateral THA in this prospective cross-sectional study. Blood samples were collected for C-reactive protein and cytokine levels, including IL-1β, IL-2, IL-6, IL-8, and tumor necrosis factor α (TNF-α), from patients before and 24 hours after surgery. Cytokine response of whole blood was evaluated ex vivo with or without two standard activators, phorbol-12-myristate-13-acetate and lipopolysaccharide, using standardized blood sample from patients at 24 hours. These standard immune activators are implicated in the inflammatory response to gram-negative infection, translocation of microbial products, pathophysiology of septic shock syndrome in human, and tumor promotion. Pain response was gauged using verbal pain scores (on a 0- to 10-point scale, where 0 = no pain and 10 = worst pain) at rest and with activity at 24 hours after surgery and analgesic consumption of volume of epidural analgesic solution for the first 24 hours after surgery.

Results

No correlation was found between BMI and postoperative spontaneous circulating cytokine levels. However, after activation of blood leukocytes with lipopolysaccharide, there was a significant positive correlation between the BMI and IL-1β, IL-6, and TNF-α levels (r = 0.26–0.32; p = 0.03, p = 0.03, and p = 0.01, respectively), suggesting priming of the innate immune system in obesity and potential for excessive postoperative inflammatory response. Obesity was not associated with increased pain or analgesic consumption in the first 24 hours after surgery.

Conclusions

Obesity is associated with a proinflammatory state after THA as demonstrated by enhanced cytokine reactivity. Larger studies exploring the specific impact of obesity and inflammation on surgical outcomes, including pain, are warranted.

Level of Evidence

Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism at Seattle Children’s Hospital-University of Washington, Seattle, WA, USA

    Roja Motaghedi MD

  2. Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA

    James J. Bae MSc, Stavros G. Memtsoudis MD, PhD, David H. Kim MD, Jonathan C. Beathe MD, Leonardo Paroli MD, PhD, Jacques T. YaDeau MD, PhD, Michael A. Gordon MD, Daniel B. Maalouf MD, MPH, Yi Lin MD, PhD & Yan Ma PhD

  3. Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA

    Susanna Cunningham-Rundles PhD

  4. Department of Anesthesiology & Pain Medicine, University of Washington, 1959 NE Pacific Street, BB1461, Box 356540, Seattle, WA, 98195, USA

    Spencer S. Liu MD

Authors
  1. Roja Motaghedi MD
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  2. James J. Bae MSc
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  3. Stavros G. Memtsoudis MD, PhD
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  4. David H. Kim MD
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  5. Jonathan C. Beathe MD
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  6. Leonardo Paroli MD, PhD
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  7. Jacques T. YaDeau MD, PhD
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  8. Michael A. Gordon MD
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  9. Daniel B. Maalouf MD, MPH
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  10. Yi Lin MD, PhD
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  11. Yan Ma PhD
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  12. Susanna Cunningham-Rundles PhD
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  13. Spencer S. Liu MD
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Corresponding author

Correspondence to Spencer S. Liu MD.

Additional information

One or more of the authors certifies that he or she has received, during the study period, funding from the Department of Anesthesiology, Hospital for Special Surgery (New York, NY, USA) (SSL) and from the Clinical and Translational Science Center at Weill Cornell Medical Center (New York, NY, USA) (NIH Grant UL1TR000457) (RM). Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Hospital for Special Surgery, New York, NY, USA.

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Motaghedi, R., Bae, J.J., Memtsoudis, S.G. et al. Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty. Clin Orthop Relat Res 472, 1442–1448 (2014). https://doi.org/10.1007/s11999-013-3282-2

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  • DOI: https://doi.org/10.1007/s11999-013-3282-2

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