Effects of computer-assisted navigation versus conventional total knee arthroplasty on the levels of inflammation markers: A prospective study

Abstract

Total knee arthroplasty (TKA) is a well-established modality for the treatment of advanced knee osteoarthritis (OA). However, the detrimental effects of intramedullary reaming used in conventional TKA for distal femur cutting are of concern. Avoiding intramedullary reaming with the use of computer-assisted navigation TKA can not only provide superior prosthetic alignment, but also mitigate perioperative blood loss and the dissipation of marrow emboli. We quantified local and systemic concentrations of inflammation markers for both techniques. Forty-four participants undergoing computer-assisted navigation and 53 receiving conventional TKA for advanced knee OA were recruited between 2013/02/08 and 2015/12/09. Blood samples were collected from all participants at baseline then again at 24 and 72 hours postoperatively and analyzed by ELISA for interleukin 6 (IL-6), IL-10, tumor necrosis factor alpha (TNF-α) and transforming growth factor beta 1 (TGF-β1); these markers were also measured in Hemovac drain fluid collected at 24 and 72 hours. Serum levels of IL-6, IL-10, TNF-α and TGF-β1(unit for all markers: pg/mL) were increased from baseline by smaller increments in the navigation TKA cohort compared with the conventional TKA group at 24 hours (17.06 vs 29.39, p = 0.02; 0.51 vs 0.83, p = 0.16; –0.04 vs 0.36, p < 0.01 and –48.18 vs 63.24, p< 0.01, respectively) and at 72 hours (12.27 vs 16.87, p = 0.01; –0.40 vs 0.48, p < 0.01; 0.58 vs 0.98, p = 0.07 and –55.16 vs 63.71, p < 0.01, respectively). IL-10 levels in drainage fluids collected 24 hours after TKA were also significantly lower in the navigation group versus the conventional TKA group (8.55 vs 12.32, p < 0.01). According to our evidence, the merits of computer-assisted navigation TKA are augmented by low levels of inflammation markers.

Navigation assisted total knee arthroplasty in 54,114 patients: No increased risk in acute complications and hospital utilisation

“…Previous studies have shown that this technique can disperse fat emboli, increasing the risk for venous thromboembolism as well. The use of navigation can reduce the invasiveness of the procedure by avoiding violation of the intramedullary canal, mitigating blood loss and dissipation of marrow emboli 29 . Furthermore, Kuo et al.…”

Usefulness of an accelerometer-based navigation system in bilateral one-stage total knee arthroplasty

“…Additionally, some studies have proposed that bleeding from trimmed cancellous bone of an uncovered resection surface [5,25,26] and a soft tissue surface [3] may be more significant sources of bleeding after TKA. It has also been suggested that intramedullary reaming and insertion of conventional instruments may inevitably lead to the destruction of endothelial cells, and dissipation of marrow emboli, which may subsequently induce a more inflammatory response and risk of embolismassociated morbidities such as acute cardiac disorders [7,27,28]. Accordingly, some inflammatory markers have been shown to be associated with functional recovery and morbidities following some major orthopedic surgeries [29][30][31].…”

Tranexamic Acid Reduces Total Blood Loss and Inflammatory Response in Computer-Assisted Navigation Total Knee Arthroplasty

“…Moreover, they found that the higher the number of boluses of TXA, the lower the level of IL-6 and CRP. In CAS-TKA, Kuo et al [29] highlighted lower levels of systemic and local inflammatory markers than were observed in conventional TKA. According to the existing literature, inflammatory markers not only predict major complications, such as pneumonia, infection, or cardiovascular events, after orthopedic surgeries, but are also correlated with functional recovery after total joint arthroplasties [30–32].…”