The purpose of this study is to examine underlying physical resilience (the ability to bounce back) in response to a specific stressor (total knee replacement).
In general, a person's specific resilience (ability to bounce back from a stressor) is thought to be dependent upon that person's specific biological and genetic makeup. However, these specific elements remain poorly understood. The purpose of this study is to identify important predictors and characteristics of resilience in response to a total knee replacement by examining baseline resilience (prior to surgery) and post-surgical resilience at multiple time points, allowing us to track resilience outcomes over time.
Study Type
OBSERVATIONAL
Enrollment
297
Duke Regional Hospital
Durham, North Carolina, United States
Duke University Hospital
Durham, North Carolina, United States
Duke University Medical Center
Durham, North Carolina, United States
Change in musculoskeletal resiliency following orthopedic surgery as measured by physical activity (step counts)
As measured by a Garmin device worn by participants
Time frame: Baseline, 1 week, 1 month, 2 months, 4 months and 6 months
Change in musculoskeletal resiliency following orthopedic surgery as measured by Lower Extremity Physical Activities of Daily Living (LE PADLs)
Scores are measured from 0 to 45. Higher scores are associated with more limited LE PADLs.
Time frame: Baseline, 6 months
Change in musculoskeletal resiliency following orthopedic surgery as measured by PROMIS Pain Intensity
Scores are measured from 3 to 15. Higher scores are associated with more intense pain.
Time frame: Baseline, 1 week, 1 month, 2 months, 4 months and 6 months
Change in musculoskeletal resiliency following orthopedic surgery as measured by PROMIS Pain Interference
Scores are measured from 6 to 30. Higher scores are associated with increased pain interference.
Time frame: Baseline, 1 week, 1 month, 2 months, 4 months and 6 months
Change in cognitive resiliency following orthopedic surgery as measured by 3D-CAM.
Scored as positive or negative. Positive indicates the presence of delirium.
Time frame: Baseline, 1 week
Change in cognitive resiliency following orthopedic surgery as measured by cognitive change index (CCI) for patient.
Scores range from 20 - 100. Higher scores are associated with increased cognitive decline.
Time frame: Baseline, 1 month, 2 months, 4 months, 6 months
Change in cognitive resiliency following orthopedic surgery as measured by cognitive change index (CCI) for informant about patient.
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Scores range from 20 - 100. Higher scores are associated with increased cognitive decline.
Time frame: Baseline, 1 month, 2 months, 4 months, 6 months
Change in association between in vitro immune resiliency and resilient outcomes following elective orthopedic surgery.
Whole blood samples containing PBMCs collected before/after surgery will be challenged with LPS and influenza vaccine to assess the cellular immune response using previously identified biomarkers of resiliency and RNA-seq analysis to identify novel biomarkers and molecular signatures.
Time frame: Baseline, Post-operative Day 1
Change in dual task gait speed
Score of combined walking and verbal fluency test
Time frame: Baseline, 6 months
Change in tissue oxygenation index (TOI)
Measured using fNIRs (functional near infrared spectroscopy)
Time frame: Baseline, 6 months
Intraoperative electrocardiography (ECG) RR variability
Measured as intra-operative ECG RR intervals collected from the heart monitor
Time frame: Surgery up to three hours