Increased inflammatory response is associated with less favorable functional results 5 years after total knee arthroplasty

Lützner, Jörg; Beyer, Franziska; Lützner, Cornelia; Thomas, Peter; Summer, Burkhard

doi:10.1007/s00167-021-06836-w

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…Furthermore, this low-level in ammation persists postoperatively and affects the outcomes of TKA. This is consistent with a study by Jörg Lützner et al, which found that patients with an increased in ammatory response have poorer functional outcomes [31]. In the imaging evaluation, the JLCA is considered to re ect medial compartment narrowing due to cartilage wear and laxity of the knee ligaments.…”

Section: Discussionsupporting

confidence: 85%

The impact of metabolic syndrome on patient-reported outcome measures after primary total knee arthroplasty in osteoarthritis patients

Leng,

Gao,

Zhang

et al. 2023

Preprint

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Background As the proportion of patients with metabolic syndrome (MetS) among those undergoing total knee arthroplasty (TKA) for osteoarthritis increases annually, the impact of MetS on patient-reported outcome measures (PROMs) after TKA has been the subject of conflicting research findings. Our goal is to determine the influence of MetS on PROMs during the first year after TKA and its associated trajectory of change. Methods We reviewed data from patients receiving their primary TKA,. Using the full-length X-ray of the patient's lower limb. We calculated the Metabolic Score for Insulin Resistance (MetS-IR) to reflect the severity of metabolic syndrome and used Maximally Selected Test Statistics to divide patients into two groups based on MetS-IR. We analyzed pre- and post-TKA OKS as PROMs and further analyzed OKS pain and function subscores. Results A total of 124 patients were included in the study. The selected cutoff value for MetS-IR was 43. Patients with MetS-IR < 43 were classified as Group 1 (n=79), while those with MetS-IR ≥ 43 were classified as Group 2 (n=45). Patients in Group 2 were younger (63.26±6.23, P<0.05), had poorer preoperative OKS scores (22 (17), P<0.05), more severe intra-articular deformities (JLCA: 6.01±2.99, MAD: 33.11±19.29, P<0.05), and higher levels of inflammation (CRP: 3.67 (2.15), P<0.05). Furthermore, CRP levels remained elevated at 1 month (7.19 (4.42)) and 3 months (5.24 (2.66)) postoperatively. Although postoperative OKS scores were lower in Group 2 than in Group 1, the improvement in OKS was higher in Group 2. Multiple regression analysis showed that MetS-IR was an independent predictor of OKS (β= -0.45, -0.19, -0.17, -0.24, p<0.05) and could predict preoperative, 3-month, 6-month, and 12-month OKS. Conclusion MetS-IR has a better predictive ability for early postoperative outcomes after TKA compared to the clinical classification of metabolic syndrome. Patients with high MetS-IR show greater improvement compared to those with low MetS-IR, however, their OKS levels remain relatively lower. MetS-IR is an independent predictive factor for OKS in OA patients before and after TKA, and a higher preoperative MetS-IR suggests lower postoperative PROMs. These findings may provide valuable insights for improved understanding and management of these patients.

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Section: Discussionsupporting

confidence: 85%

The impact of metabolic syndrome on patient-reported outcome measures after primary total knee arthroplasty in osteoarthritis patients

Leng,

Gao,

Zhang

et al. 2023

Preprint

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“…Several proinflammatory cytokines have been reported to play a role in healing and pain after TKA [29,30]. It has been demonstrated that an increased inflammatory reaction after TKA results in less favorable results [31] and that cytokines were lower after being coated compared to standard TKA [32]. Surface modification of TKA may therefore result in less inflammation and better results.…”

Section: Hypersensitivity and Immunological Reactionsmentioning

confidence: 99%

Modern Coatings in Knee Arthroplasty

Lützner¹,

Altermann²,

Reyna³

et al. 2023

Arthroplasty - Advanced Techniques and Future Perspectives

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All metal implants in human bodies corrode, which results in metal ion release. This is not necessarily a problem and represents for most patients no hazard. However, both local and systemic effects are possible, including hypersensitivity. To avoid this, coatings on standard implants (mono- or multi-layer) and surface modifications have been developed and are in use. This chapter explains the background of metal ion release, biological reactions, coating technologies, biotribological and biomechanical properties, as well as the clinical results of modern knee arthroplasty implant coatings. There is no general concern about metal ion release from CoCrMo standard implants for most patients. If patients present with a confirmed metal allergy, a multilayer-coated or oxidized zirconium implant is currently the best option for these patients.

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Nickel allergy does not correlate with function after total knee arthroplasty

Chimento,

Daher,

Desai

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study is to determine if there is a relationship between clinical outcomes and nickel allergy by evaluating asymptomatic total knee arthroplasty (TKA) patients with well‐functioning implants through quantitative metal allergy (MA) testing.MethodsA prospective case series was performed on 50 patients with well‐functioning TKA of various implant types. Inclusion criteria included primary TKA with a minimum 12‐month follow‐up and Oxford knee score (OKS) ≥ 40. A commercially available Lymphocyte Transformation Test measured the amount of a hypersensitivity lymphocyte immune response after exposure to a particular antigen. MA results were stratified based on the stimulation index (SI). The Cochran–Mantel–Haenzel test was used to test the homogeneity of metal reactivities. The Wilcoxon–Mann–Whitney test was used to compare individual metal SI by gender and the association of OKS and metal SI was ascertained with the Spearman correlation.ResultsNickel, cobalt, and chromium do not have the same reactivity scores (p < 0.001), and only nickel showed reactive/highly reactive scores. Females were found to have 3.41 times the odds of males for higher Ni reactivity (p = 0.0295, odds ratio [OR], 95% confidence interval [CI] = 3.41 [1.13–10.3]) only. Clinically, there was no correlation between metal SI and OKS score by metal (Ni rho = −0.1779; Co rho = −0.0036; Cr rho = −0.1748).ConclusionThis is the first study looking at MA in well‐functioning TKA. There is no correlation between clinical results and nickel reactivity. Surgeons should exercise caution when revising a painful or poorly functioning TKA based solely on a ‘positive’ Nickel Allergy test and look for other possible reasons for failure.Level of EvidenceLevel II.

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Increased inflammatory response is associated with less favorable functional results 5 years after total knee arthroplasty

Cited by 5 publications

References 25 publications

The impact of metabolic syndrome on patient-reported outcome measures after primary total knee arthroplasty in osteoarthritis patients

The impact of metabolic syndrome on patient-reported outcome measures after primary total knee arthroplasty in osteoarthritis patients

Modern Coatings in Knee Arthroplasty

Nickel allergy does not correlate with function after total knee arthroplasty

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