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Localized cytokine responses to total knee arthroplasty and total knee revision complications.

ABSTRACT: BACKGROUND:The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly. METHODS:This exploratory study investigated tissue-level cytokines in a cohort of patients (N?=?17) in response to total knee arthroplasty and total knee revision to better understand the immune response to implants and localized infection (e.g., prosthetic joint infection). The overall goal of this study was to provide insight into the localized cytokine response of tissues and identify tissue-level markers specific to inflammation caused by implants vs. inflammation caused by infection. Tissues were collected across several anatomical locations and assayed with a panel of 20 human inflammatory cytokines to understand spatial differences in cytokine levels. RESULTS:In this study, six cytokines were elevated in implanted joints, as compared to native joints: IL-10, IL-12p70, IL-13, IL-17A, IL-4, and TNF-? (p?

SUBMITTER: Prince N

PROVIDER: S-EPMC7461261 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Localized cytokine responses to total knee arthroplasty and total knee revision complications.

Prince Nicole N Penatzer Julia A JA Dietz Matthew J MJ Boyd Jonathan W JW

Journal of translational medicine 20200831 1

<h4>Background</h4>The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly.<h4>Methods</h4>This exploratory study investigated tissue-level cytoki ...[more]

PMID: 32867801

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Project description:BackgroundRecent studies show an increase in the prevalence of iron deficiency anemia (IDA) worldwide and a concomitant rise in the number of revision total knee arthroplasty (RTKA). The literature evaluating the association between IDA and perioperative outcomes following RTKA are limited. Therefore, the purpose of this study was to determine whether IDA patients undergoing RTKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) complications; and (3) costs.MethodsUsing International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT), a retrospective query was performed from January 1st, 2005 to March 31st, 2014. The inclusion criteria consisted of those patients who have IDA undergoing RTKA. Study group patients were 1:5 ratio matched to a comparison cohort by age, sex, and various comorbidities: coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, hyperlipidemia, hypertension, obesity, and tobacco use, yielding a total of 106,534 patients within the study (n = 17,784) and control (n = 88,750) cohorts. Outcomes assessed included: in-hospital LOS, costs of care, and medical complications. Multivariate Logistic regression analyses were used to calculate the odds-ratios (OR) and respective 95% confidence intervals (95%CI). Welch's t-tests were used to compare in-hospital LOS and costs of care. Following Bonferroni-correction, a P-value less than 0.001 was considered statistically significant.ResultsIDA patients undergoing RTKA were found to have significantly higher in-hospital LOS (4-days vs. 3-days, P < 0.0001). Additionally, IDA patients were found to have significantly higher odds (OR) of medical complications (OR: 5.29, P < 0.0001) such as: pneumonia (OR: 6.86, P < 0.0001), respiratory failures (OR: 5.95, P < 0.0001), myocardial infarctions (OR: 4.31, P < 0.0001) and other complications. Furthermore, IDA patients incurred significantly higher day of surgery ($16,976.01 vs. $14,515.81, P < 0.0001) and 90-day costs ($22,548.71 vs. $16,819.15, P < 0.0001).ConclusionThe study demonstrated IDA patients undergoing RTKA have higher rates of in-hospital LOS, costs of care, and medical complications. Orthopedic surgeons and other healthcare professionals can use this information to adequately educate these patients of the potential complications following their procedure.

Project description:There is debate in the literature whether rotating hinge knee (RHK) or constrained condylar knee (CCK) prostheses lead to better clinical outcomes and survival rates in patients undergoing revision total knee arthroplasty (RTKA). The purpose of this meta-analysis is to compare the survivorship and clinical outcomes of RHK and CCK prostheses. In this meta-analysis, we reviewed studies that evaluated pain and function scores, range of motion (ROM), complications, and survival rates in patients treated with RHK or CCK with short-term (<5 years) or midterm (5-10 years) follow-up. The survivorship was considered as the time to additional surgical intervention such as removal or revision of the components. A total of 12 studies (one randomized study and 11 non-randomized studies) met the inclusion criteria and were analyzed in detail. The proportion of the knees in which short-term (<5 years) survival rates (RHK, 83/95; CCK, 111/148; odds ratio [OR] 0.52; 95% CI, 0.24-1.11; P = 0.09) and midterm (5-10 years) survival rates (RHK, 104/128; CCK, 196/234; OR 1.05; 95% CI, 0.56-1.97; P = 0.88) were evaluated did not differ significantly between RHK and CCK prostheses. In addition, there were no significant differences in ROM (95% CI: -0.40 to 9.93; P = 0.07) and complication rates (95% CI: 0.66 to 2.49; P = 0.46). In contrast, CCK groups reported significantly better pain score (95% CI: 0.50 to 2.73; P = 0.005) and function score (95% CI: 0.01 to 2.00; P = 0.05) than RHK groups. This meta-analysis revealed that 87.4% of RHK and 75.0% of CCK prostheses survive at short-term (<5 years), while 81.3% of RHK and 83.8% of CCK prostheses survive at midterm (5-10 years). The differences in standardized mean pain and function scores we detected were likely to be imperceptible to patients and almost certainly below the minimum clinically important level, despite a significant difference in both groups. Based on the findings of the current meta-analysis, RHK prostheses continue to be an option in complex RTKA with reasonable midterm survivorship.

Project description:ObjectivesAssessing the effects of diabetes mellitus (DM), non-insulin-dependent diabetes mellitus (NIDDM), and insulin-dependent diabetes mellitus (IDDM) on revision TKA (rTKA) has become increasingly imperative due to the increased rates of revisions associated with DM. This study sought to identify complications in rTKA that were independently associated with NIDDM/IDDM compared to non-diabetic (Non-DM) patients and whether IDDM was associated with specific postoperative complications compared to NIDDM.Methods and materials16,428 rTKA patients were identified from the ACS-NSQIP database from 2005 to 2016 and stratified into three separate cohorts. 12,922 (78.66%) were Non-DM, 2335 (14.21%) had NIDDM, and 1171 (7.13%) had IDDM. Univariate analyses were utilized to assess for differences in demographics, preoperative comorbidities, and postoperative complication rates. Multivariate logistic regression analyses were then employed to control for significant differences in patients characteristics to assess NIDDM and IDDM as independent risk factors for complications in comparison to Non-DM. IDDM was further analyzed as a risk factor in comparison to NIDDM for the purpose of elucidating the impact of insulin dependence on risk for postoperative complications.ResultsNIDDM was an independent risk factor for deep incisional surgical site infections (Odds Ratio (OR): 2.477) and urinary tract infections (UTI) (OR 1.862) (p?<?0.05). Compared to NIDDM, IDDM was independently associated with greater risk for pneumonia (OR 2.603), septic shock (OR 6.597), blood transfusions (OR 1.326), and an extended length of stay (OR: 1.331) (p?<?0.05). IDDM additionally increased the risk for acute renal failure (OR 3.269) and cardiac arrest (OR 3.268) (p?<?0.05) when compared to Non-DM. DM patients overall had increased rates of worse outcomes and infectious complications.ConclusionAlthough differences between diabetes and non-diabetes rTKA patients were seen, differences in complication rates between diabetes patients further divided based on insulin dependence status were also noted. Future work examining whether targeting perioperative glucose levels <200?mg/dL in DM rTKA patients decreases infectious complications is warranted. Future work analyzing the role of tranexamic acid administration and 24-h postoperative antibiotics in rTKA IDDM patients may be warranted given the elevated risk of pneumonia, septic shock, and blood transfusions.

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Localized cytokine responses to total knee arthroplasty and total knee revision complications.

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Localized cytokine responses to total knee arthroplasty and total knee revision complications.

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