Angiotensin II blockade had no effect on range of motion after total knee arthroplasty: a retrospective review

Abstract

Background Stiffness and pain from arthrofibrosis following total knee arthroplasty (TKA) is a challenging problem, and investigating methods to prevent or reduce the incidence of postoperative arthrofibrosis is critical. Studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are efficacious at preventing fibrotic disorders in the lungs, liver, kidneys, and eyes. Our aim was to determine if ACEI or ARB use postoperatively reduces the incidence of arthrofibrosis in TKA patients. Methods In a retrospective review, we analyzed 141 consecutive TKAs performed at a single institution by a single surgeon from December 2010 to December 2014. Range of motion (ROM) in patients already taking ACEI, ARB, or neither medication was compared. Independent variables recorded were gender, age, BMI, presence of diabetes or preoperative opioid or statin use, preoperative ROM, and use of ACEIs or ARBs. Dependent variables recorded were postoperative knee flexion, extension, and total arc of motion. The primary outcome variable was success or failure of achieving 118o total arc of motion postoperatively, based on a study that found significant compromise of function in TKA patients who failed to obtain this goal. Secondary endpoints were postoperative knee flexion, extension, and total arc of motion. Results The use of neither ACEIs nor ARBs showed a significant difference in attaining greater than 118° of motion postoperatively compared to controls at 6 months. Significant predictors of obtaining > 118° motion were BMI (p < 0.05), preoperative flexion (p < 0.001), and preoperative total arc of motion (p < 0.002). Significant predictors of secondary ROM outcomes were preoperative ROM and BMI. Conclusions Our study demonstrated that the principle predictor of postoperative ROM is BMI and preoperative ROM. The use of ACEIs or ARBs did not result in a greater likelihood of obtaining satisfactory ROM postoperatively.

Effect of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers on need for operative intervention for idiopathic adhesive capsulitis

“…Three recent studies have investigated the effect of ACE-Is/ARBs on the incidence of postoperative arthrofibrosis, ROM, and manipulation in total knee arthroplasty. 2 , 18 , 25 None of the three studies demonstrated significant improvement in postoperative ROM, reduction in need for MUA, or decreased revision rate. The most recently published study by Arraut et al evaluated 79 patients undergoing primary total knee arthroplasty who were prescribed losartan at least three months prior to surgery, matched with a control group of patients who were not taking losartan.…”

Lack of association between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and pain improvement in patients with oral cancer

“…The association between the use of ARBs and functional outcomes has been investigated in other human pain conditions including total knee arthroplasty, migraine and chemotherapy-induced neuropathy [16][17][18]. Patients using ARBs did not show any improvement in knee flexion scores after total knee arthroplasty and volunteers with experimental ischaemic pain [4,16]. However, in other pathologies such as migraine, Diener et al [17] demonstrated that telmisartan reduced pain severity compared to placebo.…”

Lack of association between angiotensin converting enzyme inhibitors and angiotensin receptor blockers and pain improvement in patients with oral cancer

“…The association between the use of ARBs and functional outcomes has been investigated in other human pain conditions including total knee arthroplasty, migraine and chemotherapy-induced neuropathy. [16–18] Patients using ARBs did not show any improvement in knee flexion scores after total knee arthroplasty and in volunteers with experimental ischemic pain. [4, 16] However, in other pathologies like migraine, Diener et al demonstrated that telmisartan reduced pain severity compared to placebo.…”

“…[16–18] Patients using ARBs did not show any improvement in knee flexion scores after total knee arthroplasty and in volunteers with experimental ischemic pain. [4, 16] However, in other pathologies like migraine, Diener et al demonstrated that telmisartan reduced pain severity compared to placebo. [17] Interestingly, the use of ACEis and ARBs was associated with some protection of myelinated fiber function in a mixed population of patients with chemotherapy-induced neuropathy.…”