Effect of the method of anesthetic aid on cellular immunity in periprosthetic infection of the hip joint: : a prospective open randomized study

BACKGROUND: Periprosthetic infection after primary hip replacement is a serious complication. For the anesthetic support of revision operations, both general and neuroaxial anesthesia methods can be used. The question of choosing an anesthetic aid that, with adequate modulation of the operational stress response, would have a minimal immunosuppressive effect is relevant.

AIM: To examine the effect of general and combined spinal–epidural anesthesia during revision operations in patients with periprosthetic hip joint infection on the parameters of cellular immunity.

MATERIALS AND METHODS: An open prospective randomized study was performed on 25 patients (11 women and 14 men). The patients underwent surgical interventions of revision prosthetics with the replacement of all components of the prosthesis. Group 1 (n=10) underwent general anesthesia (GA), and group 2 (n=15) underwent surgery under combined spinal–epidural anesthesia (CSEA). The indices of cellular immunity, namely, CD4+, CD8+, CD4+/CD8+, and B-lymphocytes, were evaluated. Blood sampling was performed in the morning on the day of surgery and then on days 1, 3, 5, and 7 after surgery.

RESULTS: The CD4+ (%) level in the CSEA group was significantly higher than in the GA group on days 3 and 7 after surgery (p <0.05). Changes in the percentage of CD8+ lymphocytes, the immunoregulatory index, and the percentage of B-lymphocytes between the groups had no statistically significant differences.

CONCLUSION: The CD4+ (%) level in the CSEA group was significantly higher than that in the GA group on days 3 and 7 after surgery (p <0.05). Statistically significant differences in the dynamics of CD8+, immunoregulatory index, and B-lymphocytes were not found, which may indicate a lesser effect of the type of anesthesia on these indicators.