**7. Acknowledgment**

28 Recent Advances in Arthroplasty

catabolic damages could directly influence on the very high preoperative serum TGF-β1 level. The cytokines familiar with the growth factors group are major factors responsible for the metabolic processes of chondrocytes, consequently for their homeostasis (Shin-Han et al. 2009). TGF-β have role in recruiting immune cells to site of injury and facilitates wound healing by influence for connective tissue remodeling relates with fibroblast proliferation and the synthesis of a number of extracellular matrix proteins (Cutroneo, 2007). Data on dynamic changes of postoperative serum concentration of tested cytokines showed not significant differences (p>0.05). Indeed, the postoperative results of cytokines concentration (IL-6 and TGF-β) revealed the insignificant changes in both groups of patient, regardless the disease severity. The one of possibly explanation for this finding is the significant impairment of inflammatory response due to autoimmune disease. In contrast, many reports have demonstrated the dynamics of the IL-6 increase after surgery in groups of patients with normal immune system (Minetto et al., 2006; Demura et al., 2006;

The CRP levels significantly increased after surgery. The peak level occurred at 36 hour. The changes were similar for both groups. CRP is most important factor involved in inflammatory response and may reflect the surgical magnitude. Its concentration is normally less than 10 mg/L. In this study, the elevated levels of CRP before surgery could be evidence of confirm the chronic inflammatory state. The concentration of CRP revealed

Regional anaesthesia decreases the neuroendocrine response but does not influence on the inflammatory response (Moor et al., 1994; Naito et al., 1992; Høgevold et al., 2000). Both, the regional and general anaesthesia does not significantly influence on the postoperative immunosuppression decrease [Kawasaki et al., 2007). As the matter of fact, the postoperative changes demonstrated in this study may reflect the modulation of immune

The tourniquet time seemed not to have an influence on the serum cytokines level dynamic changes. The average tourniquet time was 86.6 in group 1 and in group 2 was 95.3 minutes. The tourniquet time longer than 105 minutes was found as statistically significant according

Data on the dynamic changes of postoperative serum concentration of tested cytokines revealed the impairment response of the immune system to surgical stress, regardless of the

Together, the evidence presented above suggests that it may be possible to identify patients likely to develop a more intensive problems with wound healing and postoperative complications. In conclusion the abnormal immune system with chronic inflammatory

The future experiments has to be enlarged on the other immunological response factors evaluations including endothelial dysfunction factors. The chronic inflammatory response influence on the wound healing process has to be evaluate in details. Thus, the major role of the growth factors while fibroblastic proliferation reactions as the key pathogenic factor

process due to autoimmune disease can attenuate the cytokines response to surgery.

response to stress surgery due to the chronic inflammatory response.

Cruickshank et al., 1990).

no significant differences between groups.

to the results of previous study (Tak et al., 2000).

during rheumatoid arthritis has to be initially evaluated.

**6. Conclusion and future research** 

intensity of disease activity.

The immunological and laboratory tests have been done in the Department of Immunopathology and the Diagnostic Laboratory of the Institute of Rheumatology. Author is extremely grateful to Professor Ewa Kontny for her consultations on the immunological problems.
