Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty

Abstract

BackgroundDespite the success of total knee arthroplasty (TKA) in reducing knee pain and improving functional disability, the management of acute postoperative pain is still unsatisfactory. This study was aimed to quantitatively analyze the possible correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary TKA.MethodsPatients scheduled for unilateral primary TKA were consecutively included, the serial changes of the numerical rating scale (NRS) at rest (NRSR) and at walking (NRSW), serum inflammatory cytokines and muscle damage markers were assessed before surgery (T0) and at postoperative day 1, 2, 3 and 5 (T1-T4, respectively); while pain disability questionnaire (PDQ) and synovial fluid inflammatory cytokines were evaluated at T0. The correlations between inflammatory cytokines, muscle damage markers and pain scores were examined, and Bonferroni correction was applied for multiple comparisons.ResultsNinety six patients were included for serum markers and pain evaluations at T0-T4, while 54 (56.25%) for synovial fluid cytokines at T0. The NRSR at T1 and T2 were positively correlated with preoperative NRSW, while the NRSW at T1 to T4 were positively correlated with preoperative NRSR, NRSW and PDQ (all p < 0.05). The NRSR was positively correlated with serum PGE2, IL-6, and CK at T1; the NRSW was positively correlated with serum CRP at T1, with PGE2 and IL-6 at T1 to T3, with CK at T2 and T4, and with Mb and LDH at T1 to T4 (all p < 0.003). Meanwhile, positive correlations were observed between preoperative NRSW and synovial fluid PGE2, IL-6, IL-8, or TNF-α, as well as between PDQ and PGE2 (all p < 0.003), but no associations between postoperative pain scores and preoperative synovial fluid cytokines was found (all p ≥ 0.003). Additionally, the NRSR at T1 and T2, and NRSW at T1 to T4 were positively correlated with body mass index (all p < 0.05).ConclusionsSerum inflammatory cytokines and muscle damage markers are positively correlated with acute postoperative pain following primary TKA, and the key cytokines (CRP, PGE2, and IL-6) and markers (Mb, CK and LDH) may serve as the targets for developing novel analgesic strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1597-y) contains supplementary material, which is available to authorized users.

The antifibrinolytic and anti‐inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial

“…The anti‐inflammatory effect was maintained in the postoperative 32‐h period with prolonged administration of oral TXA. Our previous study reported a positive relationship between postoperative pain and inflammatory marker levels , and these factors may explain why the multiple‐dose regimens resulted in corresponding reductions in pain after TKA as placebo, despite an extensive multimodal analgesic approach . Our results showed that the four‐dose regimen resulted in less knee pain and swelling, which promoted earlier exercise and ambulation, faster rehabilitation and greater ROM than the other regimens.…”

Effect of manual lymph drainage for up to 10 days after total knee arthroplasty: Arandomized controlled trial

“…Pain during the inflammatory phase occurs when a chemical mediator binds to a nociceptor. White blood cells and plasma components involved in the generation of chemical mediators are recoverable from the lymph duct at the end of the inflammatory phase [3][4][5][6] . Our study rationale was to address the importance of an intervention during this acute phase.…”

“…Physical therapy programs are used to advance the recovery of patients within the constraints imposed by strong symptoms of inflammation. Inflammatory processes tend to peak from the seventh to the tenth day post surgery [3][4][5][6] . Control of postoperative pain due to inflammation is an important goal because it facilitates the initiation and maintenance of postoperative physical therapy which can ultimately improve outcomes 7,8) .…”

Orthopedic Professionals’ Recognition and Knowledge of Pain and Perceived Barriers to Optimal Pain Management at Five Hospitals

“…For instance, 37% of orthopedic patients reported pain to be severe at its highest intensity [ 5 ], where postoperative pain remains a problem that requires consensus and joint efforts [ 5 ]. Similarly, patients feel moderate to severe pain after e.g., total knee arthroplasty [ 6 ], and managing such pain remains unsatisfactory [ 7 ]. Likewise, pain in elderly surgical patients is undermanaged, to the extent that the worst pain intensity in the first post-surgery day was the best predictor of patient satisfaction [ 8 ].…”