DO PREOPERATIVE IL-1BETA, IL-6 AND TNF-ALPHA LEVELS OF PATIENTS WHO UNDERWENT TOTAL KNEE ARTHROPLASTY SURGERY AFFECT THE POSTOPERATIVE FUNCTIONAL AND STRUCTURAL RESULTS?

Abstract

Purpose: Serum cytokines were associated with symptoms and progression of osteoarthritis. It is unknown whether these cytokines have a predictive role on the severity of symptoms after total knee arthroplasty (TKA) or not. This study was performed to investigate the effect of preoperative Serum Cytokine Levels (SCL) on length of stay in hospital (LOS), postoperative pain intensity, functional status, joint position sense, and change in X-ray. Methods: Twenty-nine patients with Grade 4 osteoarthritis degeneration level were included in the study. SCL (IL-6, TNF-alpha, IL-1beta) were assessed before surgery. Pain intensity at rest/activity and lower limb alignment were evaluated preoperative, postoperative 72nd hour and 6th week. Functional status and joint position sense were assessed before surgery and 6 weeks after surgery. Length of stay in hospital was also recorded. Results: The mean age of the participants was 67.55±6.55 years. The length of stay in the hospital mean was 6.48±3.06 day (min:3, max:16 days). Preoperative IL-6 and TNF-alpha level negatively correlated with functional status in the 6th week after surgery (r=0.46; p=0.01, r=0.39; p=0.03). Also, there was a positive correlation between preoperative TNF-alpha and the lower limb alignment at the 6th week after surgery (r=0.39; p=0.04). Conclusion: Patients with osteoarthritis who had lower preoperative IL-6 and TNF-alpha levels had better functional status and better lower limb alignment in the postoperative period. So in order to decide TKA surgery timing, primarily decreasing SCL might be caused better biomechanical development after surgery. Preoperative SCL was not directly related to the length of stay in the hospital.

Keywords

• Arthroplasty
• Cytokine
• Osteoarthritis
• Preoperative.

TOTAL DİZ ARTROPLASTİ CERRAHİSİ GEÇİREN HASTALARIN CERRAHİ ÖNCESİ IL-1BETA, IL-6 VE TNFALPHA SEVİYELERİ CERRAHİ SONRASI FONKSİYONEL VE YAPISAL SONUÇLARINI ETKİLER Mİ?

Öz

Amaç: Serum sitokinleri osteoartritin semptomları ve progresyonu ile ilişkilidir. Bu sitokinlerin Total Diz Artroplastisi (TDA) sonrası semptomların şiddeti üzerinde tahmin edici bir etkisinin olup olmadığı bilinmemektedir. Bu çalışma cerrahi öncesi serum sitokin seviyelerinin (SSS) hastanede kalış, cerrahi sonrası ağrı şiddeti, fonksiyonel durum, eklem pozisyon hissi ve X-ray deki değişim üzerine etkisini göstermek amacıyla gerçekleştirildi. Yöntem: Evre 4 osteoartriti olan yirmi dokuz hasta çalışmaya dahil edildi. Cerrahi öncesi SSS (IL-6, TNF-alfa, IL-1beta) değerlendirildi. İstirahat/aktivite ağrı şiddeti ve alt ekstremite dizilim düzgünlüğü cerrahi öncesi, cerrahi sonrası 72. saat ve 6. haftada değerlendirildi. Fonksiyonel durum ve eklem pozisyon hissi cerrahi öncesi ve cerrahi sonrası 6. haftada değerlendirildi. Hastanede kalış süresi kaydedildi. Sonuçlar: Bireylerin yaş ortalaması 67,55±6,55 yıldı. Hastane kalış süresi ortalaması 6,48±3,06 gündü (en düşük:3, en yüksek:16). Cerrahi öncesi IL-6 ve TNF-alfa seviyeleri 6. haftada fonksiyonel durum ile negatif yönde koreleydi (r=0,46; p=0.01, r=0,39; p=0,03). Ayrıca, cerrahi öncesi TNF-alfa ve alt ekstremite dizilim düzgünlüğü arasında pozitif korelasyon vardı (r=0,39; p=0,04). Tartışma: Cerrahi öncesi daha düşük IL-6 ve TNF-alfa seviyesi olan osteoartritli hastalar cerrahi sonrası dönemde daha iyi fonksiyonel durum ve alt ekstremite düzgünlüğüne sahiptiler. Bu nedenle TDA cerrahisi zamanlamasına karar verebilmek için öncelikle SSS'nin azaltılması, cerrahi sonrası daha iyi bir biyomekanik gelişime neden olabilir. Cerrahi öncesi SSS hastane kalış süresi ile direk bağlantılı değildir.

Anahtar Kelimeler

• Artroplasti
• Sitokin
• Osteoartrit
• Cerrahi Öncesi

References

1. Referans1. American Academy of Orthopedic Surgeons. Arthroplasty and total joint replacement procedures [Internet]. United States:1995 [updated 2021; cited 2021]. Available from: https://orthoinfo.aaos.org/en/treatment/total-knee-replacement.
2. Referans2. Kim S. Changes in surgical loads and economic burden of hip and knee replacements in the US: 1997-2004. Arthritis Rheum. 2008; 59(4):481-8.
3. Referans3. Molloy IB, Martin BI, Moschetti WE, Jevsevar DS. Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013. J Bone Joint Surg Am. 2017 Mar 1;99(5):402-407.
4. Referans4. Dunbar MJ. Subjective outcomes after knee arthroplasty. Acta Orthop Scand Suppl. 2001; 72(301):1-63.
5. Referans5. Ries MD, Badalamente M. Arthrofibrosis after total knee arthroplasty. Clin Orthop Relat Res. 2000; (380):177-183.
6. Referans6. Carr DB, Goudas LC. Acute pain. Lancet. 1999; 353(9169):2051-208.
7. Referans7. Puolakka PA, Rorarius MG, Roviola M, Puolakka TJ, Nordhausen K, Lindgren L. Persistent pain following knee arthroplasty. Eur J Anaesthesiol. 2010 May;27(5):455-60.
8. Referans8. Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Harwin SF, Mont MA. Bicruciate-retaining total knee arthroplasty: a review. J Knee Surg. 2014 Jun;27(3):199-205.

9. Referans9. Pritchett JW. Bicruciate-retaining Total Knee Replacement Provides Satisfactory Function and Implant Survivorship at 23 Years. Clin Orthop Relat Res. 2015; 473(7):2327-2333.
10. Referans10. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, et al. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999 Aug;42(8):1722-8.
11. Referans11. Lingard EA, Katz JN, Wright EA, Sledge CB; Kinemax Outcomes Group. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004 Oct;86(10):2179-86.
12. Referans12. Imamura M, Ezquerro F, Marcon Alfieri F, Vilas Boas L, Tozetto-Mendoza TR, Chen J, et al. Serum levels of proinflammatory cytokines in painful knee osteoarthritis and sensitization. Int J Inflam. 2015;2015:329792.
13. Referans13. Livshits G, Zhai G, Hart DJ, Kato BS, Wang H, Williams FM, et al. Interleukin-6 is a significant predictor of radiographic knee osteoarthritis: The Chingford Study. Arthritis Rheum. 2009 Jul;60(7):2037-45.
14. Referans14. Kapoor M, Martel-Pelletier J, Lajeunesse D, Pelletier JP, Fahmi H. Role of proinflammatory cytokines in the pathophysiology of osteoarthritis. Nat Rev Rheumatol. 2011 Jan;7(1):33-42.
15. Referans15. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001 Jul 11;286(2):188-95. doi: 10.1001/jama.286.2.188. Erratum in: JAMA 2001 Aug 15;286(7):792.
16. Referans16. Coudeyre E, Jardin C, Givron P, Ribinik P, Revel M, Rannou F. Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines. Ann Readapt Med Phys. 2007 Apr;50(3):189-97.
17. Referans17. Gstoettner M, Raschner C, Dirnberger E, Leimser H, Krismer M. Preoperative proprioceptive training in patients with total knee arthroplasty. Knee. 2011 Aug;18(4):265-70.
18. Referans18. Zietek P, Dziedziejko V, Safranow K, Zietek J, Stępień-Słodkowska M, Bialecka M, et al. TNF-α concentrations in pre-operative synovial fluid for predicting early post-operative function and pain after fast-track total knee arthroplasty. Knee. 2016 Dec;23(6):1044-1048.
19. Referans19. Si HB, Yang TM, Zeng Y, Zhou ZK, Pei FX, Lu YR, et al. Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty. BMC Musculoskelet Disord. 2017 Jun 17;18(1):265.
20. Referans20. Azim S, Nicholson J, Rebecchi MJ, Galbavy W, Feng T, Rizwan S, et al. Interleukin-6 and leptin levels are associated with preoperative pain severity in patients with osteoarthritis but not with acute pain after total knee arthroplasty. Knee. 2018 Jan;25(1):25-33.
21. Referans21. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S240-52. doi: 10.1002/acr.20543.
22. Referans22. O'Reilly SC, Jones A, Muir KR, Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998 Oct;57(10):588-94.
23. Referans23. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005 Jan;13(1):28-33. doi: 10.1016/j.joca.2004.10.010.
24. Referans24. Baker V, Bennell K, Stillman B, Cowan S, Crossley K. Abnormal knee joint position sense in individuals with patellofemoral pain syndrome. J Orthop Res. 2002 Mar;20(2):208-14. doi: 10.1016/S0736-0266(01)00106-1.
25. Referans25. Munro BH. Statistical methods for health care research. 4th ed. Philadelphia: Lippincott/Raven Publishers; 2001.
26. Referans26. Zhang S, Huang Q, Xie J, Xu B, Cao G, Pei F. Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty. J Orthop Surg Res. 2018 Feb 2;13(1):29. doi: 10.1186/s13018-018-0729-x.
27. Referans27. Gandhi R, Santone D, Takahashi M, Dessouki O, Mahomed NN. Inflammatory predictors of ongoing pain 2 years following knee replacement surgery. Knee. 2013 Oct;20(5):316-8.
28. Referans28. Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol. 1993; 32(2):127-131.
29. Referans29. Cudejko T, van der Esch M, van der Leeden M, Holla J, Roorda LD, Lems W, et al. Proprioception mediates the association between systemic inflammation and muscle weakness in patients with knee osteoarthritis: Results from the Amsterdam Osteoarthritis cohort. J Rehabil Med. 2018 Jan 10;50(1):67-72.
30. Referans30. Stannus O, Jones G, Cicuttini F, Parameswaran V, Quinn S, Burgess J, et al. Circulating levels of IL-6 and TNF-α are associated with knee radiographic osteoarthritis and knee cartilage loss in older adults. Osteoarthritis Cartilage. 2010 Nov;18(11):1441-7.