Orthopaedic Surgery Elicits a Systemic Anti-Inflammatory Signature

Abstract

<jats:p>Little information is available on the functional activity of leukocytes after arthroplasty or the expansion of populations with immune suppressive properties during the acute post-operative period. Synovial fluid and matched pre- and post-surgical blood samples were collected from total hip and knee arthroplasty patients (THA and TKA, respectively) to examine the impact of surgery on peripheral blood leukocyte frequency, bactericidal activity, and inflammatory mediator expression. For spinal surgeries, inflammatory mediator production by peripheral blood mononuclear cells (PBMCs) pre- and post-surgery was examined. An expansion of immune suppressive granulocytic myeloid-derived suppressor cells (G-MDSCs) was observed following arthroplasty, which correlated with significantly increased serum interleukin-10 (IL-10) levels. Analysis of synovial fluid from THA and TKAs revealed reduced granulocyte colony-stimulating factor (G-CSF) and soluble CD40 ligand (sCD40L) and increased interleukin-6 (IL-6), monocyte chemoattractant protein 2 (CCL2) and Fms-like tyrosine kinase 3 ligand (Flt-3L) compared to pre- and post-surgical serum. For the spinal surgery cohort, stimulation of PBMCs isolated post-surgery with bacterial antigens produced significantly less pro-inflammatory (IL-1α, IL-1β, interleukin-1 receptor antagonist (IL-1RA), IL-12p40, growth-related oncogene-α/GRO-α (CXCL1) and 6Ckine (CCL21)) and more anti-inflammatory/tissue repair mediators (IL-10, G-CSF and granulocyte-macrophage colony-stimulating factor (GM-CSF)) compared to PBMCs recovered before surgery. The observed bias towards systemic anti-inflammatory changes without concomitant increases in pro-inflammatory responses may influence susceptibility to infection following orthopaedic surgery in the context of underlying co-morbidities or risk factors.</jats:p>

Robot-assisted surgery in total knee arthroplasty: trauma maker or trauma savior? A prospective, randomized cohort study

“…First, RA-TKA significantly shortened the time required for bone cutting and gap balancing: these durations were 5.3 min ( p = 0.010) and 2.2 min ( p = 0.021) shorter, respectively, with RA-TKA than with CM-TKA. The significance of this finding is that previous studies have shown that osteotomy error and repeated osteotomy during TKA can lead to excessive opening of the metaphyseal sinus, exhaustion of coagulation factors and progressive inflammatory cascade [ 21 , 22 ]. Second, although RA-TKA had a significantly longer total surgical time and operative time compared with CM-TKA, careful observation showed that the time increase was mainly concentrated in the preoperative planning and intraoperative registration stages.…”

CXCL1: Gene, Promoter, Regulation of Expression, mRNA Stability, Regulation of Activity in the Intercellular Space

“…In subsequent years, CXCL1 was shown to be a product of the growth-regulated gene ( Gro ) [ 7 , 8 ]. Since then, CXCL1 has functioned under two names: MGSA and growth-regulated (or -related) oncogene (GRO) [ 8 , 9 , 10 ]. In the early 1990s, two more chemokines were identified that were very similar to GRO [ 11 ].…”

Immunopathogenesis of Craniotomy Infection and Niche-Specific Immune Responses to Biofilm

“…IL-10 is induced by lactate released from S. aureus biofilm, which inhibits HDAC11 to induce epigenetic changes at the Il-10 promoter as well as other genes ( 41 ). G-MDSCs are also enriched in humans during PJI, and are expanded in the blood following orthopedic infection ( 151 , 152 ). This suggests that they may play an important role in dictating infection persistence and/or susceptibility, respectively.…”