A Langkilde1, T L Jakobsen2, T Q Bandholm3, J Eugen-Olsen4, T Blauenfeldt5, J Petersen6, O Andersen7. 1. Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. Electronic address: anne.langkilde@regionh.dk. 2. Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Section for Orthopaedic and Sports Rehabilitation (SOS-R), Health Centre, Nørrebro, City of Copenhagen, Denmark; Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. Electronic address: tlj26@hotmail.com. 3. Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Clinical Research Centre, Department of Physical- and Occupational Therapy, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. Electronic address: thomas.quaade.bandholm@regionh.dk. 4. Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. Electronic address: Jespereugenolsen@gmail.com. 5. Department of Infectious Disease Immunology, Statens Serum Institut, Denmark. Electronic address: THBL@ssi.dk. 6. Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Biostatistics, University of Copenhagen, Denmark. Electronic address: janne.petersen.01@regionh.dk. 7. Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. Electronic address: ove.andersen@regionh.dk.
Abstract
OBJECTIVE: Reduced function persists for many patients after total knee arthroplasty (TKA). Inflammation is part of osteoarthritis' pathophysiology, and surgery induces a marked inflammatory response. We therefore wanted to explore the role of inflammation in long-term recovery after TKA, and thus conducted this secondary analysis of our randomized controlled trial (RCT) of physical rehabilitation ± progressive strength training (PST). We aimed to investigate whether (1) inflammation is associated with functional performance, knee-extension strength, and knee pain before TKA; (2) PST affects inflammation, and the inflammatory state over time; (3) baseline or surgery-induced inflammation modifies the effect of rehabilitation ± PST on change in 6-min walk test (Δ6MWT); and (4) baseline or surgery-induced inflammation is associated with Δ6MWT following TKA. DESIGN: In the primary trial report's per-protocol analysis, 72/82 patients were included. Sixty had ≥1 blood sample before and after TKA, and were included in this secondary analysis. Inflammation was measured by interferon γ-inducible protein (IP)-10, soluble urokinase plasminogen activator receptor (suPAR), interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α at baseline; day 1, week 4, 8, and 26 after TKA. RESULTS: At baseline, suPAR (P = 006) was negatively associated with 6MWT. Neither baseline nor surgery-induced inflammation modified the response to rehabilitation ± PST. Only surgery-induced IL-10 was associated with Δ6MWT26 weeks-baseline (P = 0.001), also adjusted for 6MWTbaseline, age, sex and body mass index (BMI). CONCLUSION: In this secondary analysis, only increased surgery-induced IL-10 response was associated with decreased long-term functional performance after TKA. The importance of controlling the surgery-induced immune response remains to be investigated further. TRIAL IDENTIFICATION: NCT01351831.
RCT Entities:
OBJECTIVE: Reduced function persists for many patients after total knee arthroplasty (TKA). Inflammation is part of osteoarthritis' pathophysiology, and surgery induces a marked inflammatory response. We therefore wanted to explore the role of inflammation in long-term recovery after TKA, and thus conducted this secondary analysis of our randomized controlled trial (RCT) of physical rehabilitation ± progressive strength training (PST). We aimed to investigate whether (1) inflammation is associated with functional performance, knee-extension strength, and knee pain before TKA; (2) PST affects inflammation, and the inflammatory state over time; (3) baseline or surgery-induced inflammation modifies the effect of rehabilitation ± PST on change in 6-min walk test (Δ6MWT); and (4) baseline or surgery-induced inflammation is associated with Δ6MWT following TKA. DESIGN: In the primary trial report's per-protocol analysis, 72/82 patients were included. Sixty had ≥1 blood sample before and after TKA, and were included in this secondary analysis. Inflammation was measured by interferon γ-inducible protein (IP)-10, soluble urokinase plasminogen activator receptor (suPAR), interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α at baseline; day 1, week 4, 8, and 26 after TKA. RESULTS: At baseline, suPAR (P = 006) was negatively associated with 6MWT. Neither baseline nor surgery-induced inflammation modified the response to rehabilitation ± PST. Only surgery-induced IL-10 was associated with Δ6MWT26 weeks-baseline (P = 0.001), also adjusted for 6MWTbaseline, age, sex and body mass index (BMI). CONCLUSION: In this secondary analysis, only increased surgery-induced IL-10 response was associated with decreased long-term functional performance after TKA. The importance of controlling the surgery-induced immune response remains to be investigated further. TRIAL IDENTIFICATION: NCT01351831.
Authors: Jodie L Morris; Hayley L Letson; Peter McEwen; Erik Biros; Constantin Dlaska; Kaushik Hazratwala; Matthew Wilkinson; Geoffrey P Dobson Journal: J Orthop Surg Res Date: 2021-12-20 Impact factor: 2.359