Objective
The microbiome is recognized as a new frontier in medicine with connections to a variety of diseases. We aimed to evaluate the association of lipopolysaccharide (LPS), a key proinflammatory product of the microbiome, with severity of inflammation, symptoms and radiographic abnormalities of knee osteoarthritis (OA).
Design
LPS was measured using a recombinant factor C assay, carefully optimized for systemic and synovial fluid (SF) analyses. LPS binding protein (LBP) was tested in both serum and synovial fluid of 25 patients (31 knees) from the Etarfolatide cohort for association with OA phenotypic outcomes. Models were adjusted for age, gender and body mass index.
Results
Based on LPS spike-and recovery, both serum and synovial fluid dilutions of 0.1% were required to achieve recovery rates of at least 75% in all test specimens. Low coefficients of variation (<10%) were achieved with both serum and synovial fluid dilutions <0.2%. Serum LPS and LBP were associated with the abundance of activated macrophages in the knee joint capsule and synovium. SF LPS and LBP were associated with the abundance of activated macrophages in the synovium. Serum LPS, LBP and SF LPS were associated with knee osteophyte severity. SF LPS was positively associated with knee joint space narrowing severity and total WOMAC score. SF LBP was positively associated with self-reported knee pain score.
Conclusion
These data strongly support a role for LPS in the pathogenesis and severity of structural abnormalities and symptoms of knee OA.
BackgroundWe aimed to compare the effect of tourniquet use or lack of it on recovery following uncomplicated primary total knee arthroplasty (TKA).MethodsIn a prospective randomised double-blinded study, 150 patients undergoing primary TKA were assigned to either a tourniquet or non-tourniquet group. At the early phase, 3 and 6 months after surgery, an independent observer assessed the primary outcome measure (i.e. total blood loss) and secondary outcome measures (i.e. wound complications, visual analogue scale pain score and knee range of motion).ResultsThe tourniquet group exhibited reduced intraoperative blood loss (215.7 ± 113.7 ml vs. 138.6 ± 93.9 ml, P < 0.001) and shorter operating time (77.2 ± 14.5 min vs. 82.0 ± 12.7 min, P = 0.038). However, the non-tourniquet group showed less postoperative blood loss (180.2 ± 117.0 ml vs. 253.7 ± 144.2 ml, P = 0.001) and drainage volume (89.2 ± 66.3 ml vs. 164.5 ± 97.8 ml, P = 0.004), less thigh pain (all P < 0.001) in the initial 3 weeks, better knee range of motion (ROM) in the initial 3 days (day 1 81.6 ± 17.1 vs. 75.95 ± 14.55, P = 0.036; day 3 99.8 ± 13.7 vs. 93.95 ± 11.15, P = 0.005) and fewer wound tension vesicles (10.3 vs. 29.2%, P = 0.005). Earlier straight-leg raising (4.6 ± 3.8 h vs. 6.4 ± 4.3 h, P = 0.01) and shorter length of stay (6.3 ± 1.7 days vs. 7.1 ± 1.9 days, P = 0.001) were found in the non-tourniquet group. Similar total blood loss and blood transfusion rate were observed for both groups. All other parameters revealed no significant differences.ConclusionsOur study suggests that a non-tourniquet TKA would lead to early rehabilitation without increasing side effects.Trial registrationChinese Clinical Trials Registry, ChiCTR-IOR-16007851, 1/29/2016
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