TNF-α concentrations in pre-operative synovial fluid for predicting early post-operative function and pain after fast-track total knee arthroplasty

Ziętek, Paweł; Dziedziejko, Violetta; Safranow, Krzysztof; Ziętek, Joanna; Stępień–Słodkowska, Marta; Białecka, Monika; Ziętek, Maciej; Kotrych, Daniel; Kamiński, Adam; Kowalska, Aleksandra J.

doi:10.1016/j.knee.2016.02.013

Cited by 14 publications

(16 citation statements)

References 31 publications

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“…Previous studies have measured pre‐ or peri‐operative levels of TNF‐α and IL‐6 . We found TNF‐α threefold higher in revision versus primary SF, supporting a possible role in promoting pain and inflammation.…”

Section: Discussionsupporting

confidence: 70%

“…Knee pain and stiffness is a devastating complication following total knee replacement yet our understanding of the biology of the painful TKA remains incomplete . Previous studies have tested the hypothesis that the level of inflammation pre‐ or peri‐operatively is correlated with clinical outcome and/or pain . Here, we have studied a group of patients undergoing revision surgery for all causes (having excluded infection).…”

Section: Discussionmentioning

confidence: 99%

“…6 Previous studies have tested the hypothesis that the level of inflammation pre-or peri-operatively is correlated with clinical outcome and/or pain. 10,11 Here, we have studied a group of patients undergoing revision surgery for all causes (having excluded infection). We report that in patients undergoing revision surgery, who have higher pain scores than primary TKA patients, there is elevation of key inflammatory mediators in SF and knee tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Gandhi et al studied 28 patients undergoing TKA and found that higher preoperative levels of tumor necrosis factor α (TNF‐α), matrix metallopeptidase 13, and IL‐6 in synovial fluid (SF) were associated with reduced improvement in pain scores 2 years following TKA. Conversely, Zietek et al measured TNF‐α levels in SF taken at time of primary surgery, and showed that higher levels of TNF‐α were positively correlated with improved pain scores at 6 weeks post‐surgery. Ugraş et al measured SF levels of IL‐6 and CRP 24 h postoperatively (sampling through a drainage tube placed intra‐operatively) and found that higher levels of IL‐6 were associated with slower recovery.…”

mentioning

confidence: 99%

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Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

Paish

Baldock

Gillespie

et al. 2019

Journal Orthopaedic Research

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Chronic pain and restricted knee motion is a significant problem following the total knee arthroplasty (TKA). The molecular pathogenesis of pain post‐TKA is not known and no targeted therapeutic intervention is available. The aim of this study was to investigate whether pro‐inflammatory mediators are elevated in revision knee patients, indicating an active, ongoing inflammatory process that may contribute to pain. Twelve key markers (pro‐inflammatory cytokines granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], interleukin 5 [IL‐5], IL‐8 and IL‐10, chemokines CCL2, CCL3, CCL4, and CCL13, mediators of angiogenesis Flt‐1, vascular endothelial growth factor, and cell migration vascular cell adhesion molecule 1 and intercellular adhesion molecule 1) were measured in knee tissue and synovial fluid (SF) from primary TKA (n = 29) and revision patients (n = 32). Indications for surgery were osteoarthritis (OA) for primary TKA, and component loosening (n = 11), stiffness (n = 11), laxity pattern (n = 8), or progression of OA in patella resurfacing (n = 3) for revision surgery. Pain levels (WOMAC score) were higher in revision than primary patients (p ≤ 0.05). Time from primary to revision ranged from 8 months to 30 years (median 10 years). All markers were elevated in revision TKA; there was no trend toward decreasing levels with greater time from primary surgery for any marker studied in SF. Similar results were seen in knee tissue. We found no differences comparing indications for revision surgery (p ≥ 0.05). The elevation of inflammatory mediators in painful post‐TKA knees requiring revision suggests active, chronic inflammation. Characterization of upregulated markers provides rationale for targeted therapy, even many years from the primary surgery. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2316–2324, 2019

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

Paish

Baldock

Gillespie

et al. 2019

Journal Orthopaedic Research

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“…Additionally, most orthopedic surgeons believe that ACL reconstruction prevents further instability; however, no consensus exists on whether surgery can reduce the risk of PTOA [8]. Additionally, changes in the molecular milieu of the damaged knee joint—such as greater inflammatory reactions, e.g., tumor necrosis factor-alpha (TNF-α) expression [9] and cell apoptosis (i.e., caspase-3) [10]—directly increase the development of OA. Therefore, the acute settling of balanced homeostasis in the injured joint cavity plays a decisive role in the degradation and synthesis of articular cartilage.…”

Section: Introductionmentioning

confidence: 99%

Can Early Rehabilitation Prevent Posttraumatic Osteoarthritis in the Patellofemoral Joint after Anterior Cruciate Ligament Rupture? Understanding the Pathological Features

Chang

Shie

Lee

et al. 2017

IJMS

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Knee instability resulting from anterior cruciate ligament (ACL) rupture is a high-risk factor for posttraumatic osteoarthritis (PTOA) in the patellofemoral joint (PFJ). However, whether non-weight-bearing and weight-bearing treatments have chondroprotective effects remains unclear. Twenty-four adult New Zealand White male rabbits were employed in this study. All animals received ACL transection in the right knee and sham surgery in the left knee. The rabbits were randomly assigned to the following groups: (I) In the sedentary (SED) group, the rabbits (n = 6) were simply kept in their cage; (II) In the continuous passive motion (CPM) group, the rabbits (n = 6) performed CPM exercise for 7 days, starting from the first postoperative day; (III) In the active treadmill exercise (TRE) group, the rabbits (n = 6) performed TRE for 2 weeks; (IV) In the CPM + TRE group, the rabbits (n = 6) executed CPM exercise, followed by TRE. Two joint surfaces (the retropatella and femoral trochlear groove) were assessed at 4 weeks after operation. Although the gross appearance in each group was comparable, histological examination revealed significant differences in the articular cartilage status. The CPM group exhibited a greater thickness of articular cartilage, maintenance of tidemark continuity, abundant glycosaminoglycan (GAG), and significantly lower inflammatory cytokine 9, e.g., tumor necrosis factor-alpha (TNF-α) 0 levels, with modest cell apoptosis (i.e., caspase-3). By contrast, the TRE group displayed the worst pathological features: an irregular cartilage surface and chondrocyte disorganization, reduced cartilage thickness, breakdown of the tidemark, depletion of collagen fibers, loss of GAG, and the highest levels of TNF-α and caspase-3 expression. Furthermore, the CPM + TRE group had more favorable outcomes than the SED group, indicating that suitable exercise is needed. The sham treatment displayed no variance in the changes in the two joint surfaces among groups. These data indicate that the application of early CPM rehabilitation is suggested for subjects in order to decrease the risk of PTOA without ACL reconstruction in the PFJ compartment in rabbits. The early TRE program, however, had harmful outcomes. Additionally, inactivity was discovered to initiate the development of PTOA.

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Predictive Factors for Developing Chronic Pain After Total Knee Arthroplasty

Kim

Pearson-Chauhan

McCarthy

et al. 2018

The Journal of Arthroplasty

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TNF-α concentrations in pre-operative synovial fluid for predicting early post-operative function and pain after fast-track total knee arthroplasty

Cited by 14 publications

References 31 publications

Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

Can Early Rehabilitation Prevent Posttraumatic Osteoarthritis in the Patellofemoral Joint after Anterior Cruciate Ligament Rupture? Understanding the Pathological Features

Predictive Factors for Developing Chronic Pain After Total Knee Arthroplasty

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