**1. Introduction**

14 Recent Advances in Arthroplasty

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[pii]

Surgical injury evokes an injury response involving immunologic mechanisms. Alterations in the immune response after surgery are recognized as physiological reactions of the organism to restore its homeostasis. The immune responses are characterized by the release of cytokines, inflammatory mediators and acute-phase proteins. The activation of immune cells is followed by the release of various cytokines as well as by a migration of leukocytes into inflamed tissues. Cytokines play roles in the immune response, inflammatory reaction and homeostasis maintaining. Alternations of cytokines concentration in patients with normal immune system function are probably not sufficient and temporary to cause the relevant immune problems postoperative. Moreover, this response is characterized by proper balance between pro-and anti-inflammatory cytokines. Conversely, in patients with chronic inflammatory state the surgery stimulated immune response can be an additional aggravating factor that can contribute to the weakening or pathological intensification of the response.

The surgery is associated with trauma-related immunological changes. The level of these immunological changes directly correlates with the degree of tissue damage. Both surgery and anesthesia are immunosuppressive factors, but regional anesthesia seems to be less than general anesthesia.

Rheumatoid arthritis is an autoimmune disorder characterized by immune-mediated chronic inflammation including a degradation of the connective tissue and bone. The chronic inflammatory state is related with a strong prolonged stimulation of the immune system including a release of the complete cytokines cascade and inflammatory mediators targeted against self cells. So suddenly and unexpectly the friend turns into the enemy with a excited powerful destructive force.
