Regional differences in temperature course after knee arthroplasty

Skin Temperature Following Total Knee Arthroplasty: A Longitudinal Observational Study

BACKGROUND

Total knee arthroplasty (TKA) is the most effective method of pain relief and increased functional status for end-stage knee arthritis. We aimed to assess in patients undergoing unilateral, primary TKA whether the temperature of the operated limb, compared to the nonoperative limb, remains elevated up to 1 year postoperatively.

METHODS

Using a prospective, longitudinal, observational study design, 1,094 patients were enrolled, and 889 patients completed a minimum of 4 out of 5 follow-up appointments. There were 864 patients who had a normal postoperative course, while 25 patients were deemed to have a superficial or deep infection. Skin temperatures were measured using an infrared thermometer on the operated and nonoperated knees preoperatively, at 2, 6, 12 weeks, and 1 year postoperatively. A subgroup analysis was performed on the 25 patients deemed to have a superficial or deep infection.

RESULTS

There was a statistically significant increase in skin temperature in the operated versus nonoperated knee at every follow-up, with a P < .001. However, the effect size was small at the 1-year follow-up, with a mean difference in skin temperature of 0.3 °C. In the infected subgroup, there was a statistically significant difference in skin temperature at 2, 6, and 12 weeks, with a greater difference in skin temperature between the operated and nonoperated knees (4.05 versus 3.78 °C in the noninfected). However, there was little clinical difference (0.27 °C) at 2 weeks between infected and noninfected patients.

CONCLUSIONS

This study could improve postoperative interactions between patients and surgeons. It is normal for skin temperature post-TKA to increase initially and improve over time, but it can take up to 1 year before there is little clinical difference. Because of the small difference in the rise of skin temperature between infected and noninfected patients, there is little indication that skin temperature is a reliable indicator of infection.

Use of Infrared Thermography in Medical Diagnosis, Screening, and Disease Monitoring: A Scoping Review

Thermography provides non-invasive, radiation-free diagnostic imaging. Despite the extensive literature on medical thermography, a comprehensive overview of current applications is lacking. Hence, the aim of this scoping review is to identify the medical applications of passive infrared thermography and to catalogue the technical and environmental modalities. The diagnostic performance of thermography and the existence of specific reference data are evaluated, and research gaps and future tasks identified. The entire review process followed the Joanna Briggs Institute (JBI) approach and the results are reported according to PRISMA-ScR guidelines. The scoping review protocol is registered at the Open Science Framework (OSF). PubMed, CENTRAL, Embase, Web of Science, OpenGrey, OSF, and PROSPERO were searched using pretested search strategies based on the Population, Concept, Context (PCC) approach. According to the eligibility criteria, references were screened by two researchers independently. Seventy-two research articles were identified describing screening, diagnostic, or monitoring studies investigating the potential of thermography in a total of 17,314 participants within 38 different health conditions across 13 therapeutic areas. The use of several camera models from various manufacturers is described. These and other facts and figures are compiled and presented in a detailed, descriptive tabular and visual format. Thermography offers promising diagnostic capabilities, alone or in addition to conventional methods.

Thermal imaging in total knee replacement and its relation with inflammation markers

Total knee replacement is an end-stage surgical treatment of osteoarthritis patients to improve their quality of life. The study presents a thermal imaging-based approach to assess the recovery of operated-knees. The study focuses on the potential of thermal imaging for total knee replacement and its relation with clinical inflammatory markers. A total of 20 patients with bilateral knee replacement were included for thermal imaging and serology, where data was acquired on pre-operative day and five post-operative days. To quantify the inflammation, the temperature-based parameters (like mean differential temperature, relative percentage of raised temperature) were evaluated from thermal images, while the clinically proven inflammation markers were obtained from blood samples for clinical validation. Initially, the knee region was segmented by applying the automatic method, subsequently, the mean skin temperature was calculated and investigated for a statistical relevant relationship with inflammatory markers. After surgery, the mean skin temperature was first increased (>2.15 ℃ for different views) then settled to pre-operative level by 90th day. Consequently, the mean differential temperature showed a strong correlation with erythrocyte sedimentation rate (r > 0.893) and C-reactive protein (r > 0.955). Also, the visual profile and relative percentage of raised temperature showed promising results in quantifying the temperature changes both qualitatively and quantitatively. This study provides an automatic and non-invasive way of screening the patients for raised levels of skin temperature, which can be a sign of inflammation. Hence, the proposed temperature-based technique can help the clinicians for visual assessment of post-operative recovery of patients.

A Systematic Review on the Value of Infrared Thermography in the Early Detection of Periprosthetic Joint Infections

BACKGROUND

Variations in the temperature of body and skin are symptoms of many pathological changes. Although joint replacement surgery of hip and knee has been very successful in recent decades, periprosthetic infection is a growing problem and the number one reason for revision. While many studies have investigated changes in blood levels, investigation of temperature has not been performed on a regular basis. The objective of this work is to determine whether reference literature exists for the infrared thermographic examination in knee and hip arthroplasty and if reference values can be derived for the methodology or if there is a peri- and postoperative benefit.

MATERIAL UND METHODS

By means of a systematic online database search and based on the Cochrane, PICOT and PRISMA guidelines, this systematic review retrieved 254 studies. All publications with thermographic examination in arthroplasty of the hip and knee were imbedded. 249 studies were excluded due to the defined inclusion and exclusion criteria and five studies with 251 patients have finally been included in the evaluation process. This was followed by an analysis and discussion of the methodology.

RESULTS AND CONCLUSION

Infrared thermography is a useful tool in the perioperative care of patients after arthroplasty of the knee and hip joint. The technology is portable, easy to use and non-invasive. Based only on these few publications, values can be derived, which provide a guidance for the thermographic aftercare in arthroplasty surgery.

Effect of Celecoxib on Surgical Site Inflammation after Total Knee Arthroplasty: A Randomized Controlled Study

OBJECTIVE

To evaluate the anti-inflammatory effectiveness of celecoxib and its effect on the rehabilitation of joint function after total knee arthroplasty.

METHODS

72 patients presented between 2016 and 2017 and were divided into two groups. The experimental group was given 200 mg celecoxib twice daily with tramadol hydrochloride 50 mg twice daily (as required); the control group was given tramadol hydrochloride 50 mg twice daily for 6 weeks from the first day after total knee arthroplasty. Skin temperature around the knee was measured 1 day before surgery, on postoperative days 1 and 3, and at weeks 1, 2, and 6. Inflammatory markers (white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and interleukin-6) were measured preoperatively, on postoperative day 3, and at weeks 1 and 6. Knee Society Score was recorded preoperatively and at postoperative weeks 1, 2, and 6.

RESULTS

Except for preoperative skin temperature, the recorded skin temperatures of the experimental group were significantly different compared to those of the control group (p = 0.001, 0.024, 0.030, 0.041, 0.047, respectively). Levels of C-reactive protein were significantly different at the 1st and the 6th week after surgery, differing by 19.3 ± 4.64 mg/L (p < 0.001) and 2.6 ± 0.92 mg/L (p = 0.006). Levels of interleukin-6 showed a significant difference of 6.61 ± 2.36 pg/mL (p = 0.007) at the 1st week after surgery. Until the 6th week after surgery, the erythrocyte sedimentation rate in the experimental group and the control group differed by 17 ± 4.6 mm/h (p = 0.001).

CONCLUSIONS

Celecoxib has a significant inhibitory effect on postoperative aseptic inflammation.

Effects of Kinesio taping compared to arterio-venous Impulse System™ on limb swelling and skin temperature after total knee arthroplasty

PURPOSE

It is an established fact that post-operative (p.o.) soft-tissue swelling and lymphoedema after total knee arthroplasty (TKA) have a major influence on the p.o. early functional outcome. Kinesio taping has a proven clinical effect in increasing lymph drainage. Despite the decades of experience gained and the assumed positive effects, hardly any investigations have been conducted to date on the influence of Kinesio taping on the p.o. healing process after TKA. The objective of the present study was to test the hypothesis that Kinesio taping used as a lymph application leads to a reduction of p.o. soft-tissue swelling. As a secondary objective, it was to be tested whether there is an effect on skin temperature as a surrogate parameter for dermal micro-circulation.

METHODS

In this prospective study with a historical control (A-V Impulse System™ group), 42 subjects were included and treated with Kinesio taping after implantation of a TKA. The patients of the study group were treated immediately p.o. with Kinesio® Tex Gold™ fan cut tape as a lymph application with a common base. A thermographic temperature determination of the knee joint operated on was performed on each patient in the supine position every day from the first to the seventh p.o. day. The leg circumference was documented daily at eight specified measuring points on both lower limbs. As a statistical analytical approach, the so-called principal component analysis was used. An analysis of variance was performed. The significance level was set at p < 0.001.

RESULTS

The course of soft-tissue swelling of the study group did not differ from that of the control group at any point in time. For the temperature course of the medial wound aspect, no difference was seen between the Kinesio taping study group and the A-V Impulse System™ group. In contrast, the temperature course of the lateral wound aspect showed a reproducibly higher temperature in the Kinesio tape group than in the control group (0.6 °C (0.5-0.8), p < 0.001).

CONCLUSION

The hypothesis of the study that Kinesio taping as a lymph application induces a reduction of soft-tissue swelling after TKA must be rejected on the basis of the present data. Solely the temperature of the lateral wound aspect was higher in the Kinesio taping group than in the control group, so that an increased blood circulation can be assumed here. Considering that the actively working A-V Impulse System™ used in the control group also increases local blood circulation, the effect of the passive Kinesio tape is surprising. However, this was not reflected in a quicker wound healing, as the day of last wound secretion was the same in both groups. Kinesio taping as a lymph application represents an equivalent alternative to the A-V Impulse System™ for therapy after total knee arthroplasty with regard to soft-tissue swelling and wound healing.