Inflammation and post-operative recovery in patients undergoing total knee arthroplasty-secondary analysis of a randomized controlled trial

Langkilde, Anne; Jakobsen, Thomas; Bandholm, Thomas; Eugen‐Olsen, Jesper; Blauenfeldt, Thomas; Petersen, Janne; Andersen, Ove

doi:10.1016/j.joca.2017.03.008

Cited by 39 publications

(25 citation statements)

References 51 publications

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“…Indeed, our recent study reported that IL-10 levels were significantly increased in patients with PJI compared to aseptic loosening [ 16 ] and in a mouse PJI model IL-10 was critical for promoting S. aureus persistence, in part, via inhibition of monocyte/macrophage pro-inflammatory activity that was mediated by MDSCs [ 11 ]. Elevated IL-10 levels have also been associated with impaired long-term functional performance following TKA [ 39 ] as well as in patients with traumatic bone injuries, which was predictive of sepsis development [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic Surgery Elicits a Systemic Anti-Inflammatory Signature

Heim

Yamada

Fallet

et al. 2020

JCM

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Little information is available on the functional activity of leukocytes after arthroplasty or the expansion of populations with immune suppressive properties during the acute post-operative period. Synovial fluid and matched pre- and post-surgical blood samples were collected from total hip and knee arthroplasty patients (THA and TKA, respectively) to examine the impact of surgery on peripheral blood leukocyte frequency, bactericidal activity, and inflammatory mediator expression. For spinal surgeries, inflammatory mediator production by peripheral blood mononuclear cells (PBMCs) pre- and post-surgery was examined. An expansion of immune suppressive granulocytic myeloid-derived suppressor cells (G-MDSCs) was observed following arthroplasty, which correlated with significantly increased serum interleukin-10 (IL-10) levels. Analysis of synovial fluid from THA and TKAs revealed reduced granulocyte colony-stimulating factor (G-CSF) and soluble CD40 ligand (sCD40L) and increased interleukin-6 (IL-6), monocyte chemoattractant protein 2 (CCL2) and Fms-like tyrosine kinase 3 ligand (Flt-3L) compared to pre- and post-surgical serum. For the spinal surgery cohort, stimulation of PBMCs isolated post-surgery with bacterial antigens produced significantly less pro-inflammatory (IL-1α, IL-1β, interleukin-1 receptor antagonist (IL-1RA), IL-12p40, growth-related oncogene-α/GRO-α (CXCL1) and 6Ckine (CCL21)) and more anti-inflammatory/tissue repair mediators (IL-10, G-CSF and granulocyte-macrophage colony-stimulating factor (GM-CSF)) compared to PBMCs recovered before surgery. The observed bias towards systemic anti-inflammatory changes without concomitant increases in pro-inflammatory responses may influence susceptibility to infection following orthopaedic surgery in the context of underlying co-morbidities or risk factors.

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Section: Discussionmentioning

confidence: 99%

Orthopaedic Surgery Elicits a Systemic Anti-Inflammatory Signature

Heim

Yamada

Fallet

et al. 2020

JCM

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“…by smoking [30]), as well as proinflammatory cytokine receptors activate the transcription factors NF-κB and AP-1 that bind the promoter region of the gene for uPAR/suPAR, PLAUR , and upregulate expression of uPAR [31]. In contrast, stimulation of whole blood with suPAR has little or no effect on the expression of inflammatory cytokines [32]. Hence, suPAR may be a less functionally active biomarker and therefore allowed to freely circulate, in contrast to most proinflammatory cytokines with strong local acting immune effects.…”

Section: Discussionmentioning

confidence: 99%

Healthy lifestyles reduce suPAR and mortality in a Danish general population study

et al. 2019

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BackgroundThe plasma level of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is a strong predictor of disease development and premature mortality in the general population. Unhealthy lifestyle habits such as smoking or unhealthy eating is known to elevate the suPAR level. We aimed to investigate whether change in lifestyle habits impact on the suPAR level, and whether the resultant levels are associated with mortality.ResultsPaired suPAR measurements from baseline- and the 5-year visit of the population-based Inter99 study were compared with the habits of diet, smoking, alcohol consumption, and physical activity. Paired suPAR measurements for 3225 individuals were analyzed by linear regression, adjusted for demographics and lifestyle habits. Compared to individuals with a healthy lifestyle, an unhealthy diet, low physical activity, and daily smoking were associated with a 5.9, 12.8, and 17.6% higher 5-year suPAR, respectively. During 6.1 years of follow-up after the 5-year visit, 1.6% of those with a low suPAR (mean 2.93 ng/ml) died compared with 3.8% of individuals with a high suPAR (mean 4.73 ng/ml), P < 0.001. In Cox regression analysis, adjusted for demographics and lifestyle, the hazard ratio for mortality per 5-year suPAR doubling was 2.03 (95% CI: 1.22–3.37).ConclusionLifestyle has a considerable impact on suPAR levels; the combination of unhealthy habits was associated with 44% higher 5-year suPAR values and the 5-year suPAR was a strong predictor of mortality. We propose suPAR as a candidate biomarker for lifestyle changes as well as the subsequent risk of mortality.

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“…Hall et al examined 102 patients undergoing THA and found that serum IL-6 levels at 24 hours after THA correlated with the recovery time to walk for 10 and 25 minutes. The extent of inflammation also correlated with functional recovery after TKA [ 8 ]. Langkilde et al recruited 60 patients undergoing TKA and found that at 26 weeks after surgery, IL-10 levels were negatively associated with the gain in walking distance.…”

Section: Discussionmentioning

confidence: 99%

“…We consider that the lowering of TGF-β1 levels after removal of severe arthritic tissue exceeded the increase in TGF-β1 induced by surgical trauma, leading to an overall decline in TGF-β1 after navigation TKA. Similarly, IL-10 is considered to reflect the extent of arthritic severity and the extent of surgery-induced trauma [ 8 , 19 ]. Comparable serum IL-10 levels seen before and after navigation TKA may be due to a balanced effect between removal of severe arthritic tissue and surgery-induced trauma.…”

Section: Discussionmentioning

confidence: 99%

“…The minimum sample size required for each group was calculated because of the pilot nature of the study. The priori power calculation (G*Power 3.1.9.2 software: http://www.gpower.hhu.de/en.html ) used a 2-tailed Wilcoxon signed-rank test to calculate the sample size of at least 27 for each group (calculated effect size: 0.8; α level: 0.05; power: 80%; allocation ratio: 1).We finally planned to enroll at least 40 patients for each group after referencing the pertinent publications[ 3 , 8 ].…”

Section: Methodsmentioning

confidence: 99%

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Effects of computer-assisted navigation versus conventional total knee arthroplasty on the levels of inflammation markers: A prospective study

et al. 2018

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Total knee arthroplasty (TKA) is a well-established modality for the treatment of advanced knee osteoarthritis (OA). However, the detrimental effects of intramedullary reaming used in conventional TKA for distal femur cutting are of concern. Avoiding intramedullary reaming with the use of computer-assisted navigation TKA can not only provide superior prosthetic alignment, but also mitigate perioperative blood loss and the dissipation of marrow emboli. We quantified local and systemic concentrations of inflammation markers for both techniques. Forty-four participants undergoing computer-assisted navigation and 53 receiving conventional TKA for advanced knee OA were recruited between 2013/02/08 and 2015/12/09. Blood samples were collected from all participants at baseline then again at 24 and 72 hours postoperatively and analyzed by ELISA for interleukin 6 (IL-6), IL-10, tumor necrosis factor alpha (TNF-α) and transforming growth factor beta 1 (TGF-β1); these markers were also measured in Hemovac drain fluid collected at 24 and 72 hours. Serum levels of IL-6, IL-10, TNF-α and TGF-β1(unit for all markers: pg/mL) were increased from baseline by smaller increments in the navigation TKA cohort compared with the conventional TKA group at 24 hours (17.06 vs 29.39, p = 0.02; 0.51 vs 0.83, p = 0.16; –0.04 vs 0.36, p < 0.01 and –48.18 vs 63.24, p< 0.01, respectively) and at 72 hours (12.27 vs 16.87, p = 0.01; –0.40 vs 0.48, p < 0.01; 0.58 vs 0.98, p = 0.07 and –55.16 vs 63.71, p < 0.01, respectively). IL-10 levels in drainage fluids collected 24 hours after TKA were also significantly lower in the navigation group versus the conventional TKA group (8.55 vs 12.32, p < 0.01). According to our evidence, the merits of computer-assisted navigation TKA are augmented by low levels of inflammation markers.

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Inflammation and post-operative recovery in patients undergoing total knee arthroplasty-secondary analysis of a randomized controlled trial

Abstract: NCT01351831.

Cited by 39 publications

References 51 publications

Orthopaedic Surgery Elicits a Systemic Anti-Inflammatory Signature

Orthopaedic Surgery Elicits a Systemic Anti-Inflammatory Signature

Healthy lifestyles reduce suPAR and mortality in a Danish general population study

Effects of computer-assisted navigation versus conventional total knee arthroplasty on the levels of inflammation markers: A prospective study

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