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Mackie M, Barton KI, Sokol-Randell D, Lanting B. The Use of Biomarkers to Quantify Clinical Response to Total Knee Arthroplasty Interventions: A Systematic Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00005. [PMID: 38547046 PMCID: PMC10977533 DOI: 10.5435/jaaosglobal-d-23-00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
The primary objective of this review was to determine whether the attenuation of the postoperative inflammatory response (PIR) after total knee arthroplasty (TKA) leads to a notable improvement in clinical outcome scores. The secondary objective of this review was to determine the optimal approach in using inflammatory biomarkers, clinical inflammatory assessments, and imaging to quantify the PIR. A systematic literature search of eight major databases was conducted using a predetermined search strategy. C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), knee surface temperature (KST), and clinical outcome data were collected and graphically displayed. Eighty-six percent of the studies that reported a statistically significant decrease in inflammatory biomarkers in their treatment group demonstrated a concordant notable improvement in clinical outcome scores. Mean CRP, IL-6, ESR, and KST values peaked on postoperative day (POD) 2, POD1, POD7, and POD 1-3, respectively. The PIR is correlated with early pain and function recovery outcomes. Future studies comparing TKA surgical methodologies and perioperative protocols should assess PIR by incorporating inflammatory biomarkers, such as CRP and IL-6, and clinical inflammatory assessment adjuncts, to provide a more comprehensive comparison.
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Affiliation(s)
- Mark Mackie
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Kristen I. Barton
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Darek Sokol-Randell
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Brent Lanting
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
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Gómez-Sánchez E, Hernández-Gómez A, Guzmán-Flores JM, Alonso-Castro AJ, Serafín-Higuera NA, Balderas-Peña LMA, Franco-de la Torre L, Isiordia-Espinoza MA. Celecoxib Decreases the Need for Rescue Analgesics after Total Knee Arthroplasty: A Meta-Analysis. Clin Pract 2024; 14:461-472. [PMID: 38525714 PMCID: PMC10961807 DOI: 10.3390/clinpract14020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the analgesic efficacy and adverse effects of celecoxib after total knee arthroplasty. Keywords in the PubMed and Scopus databases were used to find article abstracts. Each included clinical trial was assessed using the Cochrane Collaboration risk of bias tool, and we extracted data on postoperative pain assessment using the Visual Analogue Scale (VAS) at rest, ambulation, and active range of motion, rescue analgesic intake, and adverse effects. Inverse variance tests with mean differences were used to analyze the numerical variables. The Mantel-Haenszel statistical method and the odds ratio were used to evaluate the dichotomous data. According to this qualitative assessment (n = 482), two studies presented conclusions in favor of celecoxib (n = 187), one showed similar results between celecoxib and the placebo (n = 44), and three clinical trials did not draw conclusions as to the effectiveness of celecoxib versus the placebo (n = 251). Moreover, the evaluation of the rescue analgesic intake showed that the patients receiving celecoxib had a lower intake compared to patients receiving a placebo (n = 278, I2 = 82%, p = 0.006, mean difference = -6.89, 95% IC = -11.76 to -2.02). In conclusion, the pooled analysis shows that administration of celecoxib alone results in a decrease in rescue analgesic consumption compared to a placebo after total knee surgery.
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Affiliation(s)
- Eduardo Gómez-Sánchez
- División de Disciplinas Clínicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico UDG-CA-874 Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (E.G.-S.); (L.M.-A.B.-P.)
| | - Adriana Hernández-Gómez
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (A.H.-G.); (J.M.G.-F.)
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Juan Manuel Guzmán-Flores
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (A.H.-G.); (J.M.G.-F.)
| | - Angel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato 36250, Mexico;
| | | | - Luz Ma.-Adriana Balderas-Peña
- División de Disciplinas Clínicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico UDG-CA-874 Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (E.G.-S.); (L.M.-A.B.-P.)
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
| | - Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
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Motififard M, Hatami S, Feizi A, Toghyani A, Parhamfar M. Comparison of the effects of preoperative celecoxib and gabapentin on pain, functional recovery, and quality of life after total knee arthroplasty: A randomized controlled clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:50. [PMID: 37496639 PMCID: PMC10366981 DOI: 10.4103/jrms.jrms_416_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/18/2022] [Accepted: 03/22/2023] [Indexed: 07/28/2023]
Abstract
Background Acute pain is one of the main complaints of patients after total knee arthroplasty (TKA), which causes delayed mobility, increased morphine consumption, and subsequently increased costs. Therefore, the present study was performed to evaluate the preventive effect of preoperative celecoxib and gabapentin on reducing patient pain as a primary outcome after TKA surgery. Materials and Methods This randomized, double-blind controlled clinical trial was performed on 270 patients with osteoarthritis that were candidates for TKA surgery allocated into three groups. In the first group, 900 mg of gabapentin was administered orally on a daily basis for 3 days before surgery. In the second group, 200 mg of oral celecoxib was administered twice daily for 3 days before surgery. In the third group, oral placebo was administered twice daily for 3 days before the surgery. The patients' pain score and knee and its functional score were recoded. Results The mean of reduction pain in gabapentin and celecoxib groups was significantly lower than that of the control group at 12, 24, and 48 h after surgery (P < 0.001); however, two groups were not significantly different from each other (P > 0.05). Furthermore, the two medication groups were not significantly different in this regard (P > 0.05). In addition, the knee score in the gabapentin group with the means of 85.40 ± 5.47 and the celecoxib group with the means of 87.03 ± 3.97 were significantly higher than those of the control group with the means of 78.90 ± 4.39 in the 1st month after the surgery (P < 0.001). Conclusion According to the results of the present study, the preventive administration of gabapentin and celecoxib showed a significant and similar effectiveness on reducing patient pain after TKA surgery and on improving the KSS and quality of life scores.
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Affiliation(s)
- Mehdi Motififard
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Hatami
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, School of Health, Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Toghyani
- Department Faculty of Health, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Parhamfar
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Gavish L, Kandel L, Rivkin G, Gertz SD, Hoffer O. Natural history of changes in knee skin temperature following total knee arthroplasty: a systematic review and meta-analysis. Sci Rep 2023; 13:6810. [PMID: 37100814 PMCID: PMC10133306 DOI: 10.1038/s41598-023-33556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
Patients undergoing total-knee arthroplasty (TKA) have transient increases in anterior knee skin temperature (ST) that subside as recovery progresses-except in cases of systemic or local prosthetic joint infections (PJI). This meta-analysis was designed to quantify the changes in knee ST following TKA in patients with uncomplicated recovery as a prerequisite for assessing the usefulness of thermal imaging for diagnosis of PJI. This meta-analysis (PROSPERO-CRD42021269864) was performed according to PRISMA guidelines. PUBMED and EMBASE were searched for studies reporting knee ST of patients that underwent unilateral TKA with uncomplicated recovery. The primary outcome was the weighted means of the differences in ST between the operated and the non-operated knees (ΔST) for each time point (before TKA, and 1 day; 1,2, and 6 weeks; and 3,6, and 12-months post-TKA). For this analysis, 318 patients were included from 10 studies. The elevation in ST was greatest during the first 2-weeks (ΔST = 2.8 °C) and remained higher than pre-surgery levels at 4-6 weeks. At 3-months, ΔST was 1.4 °C. It decreased to 0.9 °C and 0.6 °C at 6 and 12-months respectively. Establishing the baseline profile of knee ST following TKA provides the necessary first step for evaluating the usefulness of thermography for the diagnosis of post-procedural PJI.
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Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM) and Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, POB 12272, 9112001, Jerusalem, Israel.
- The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Leonid Kandel
- Department of Orthopedics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gurion Rivkin
- Department of Orthopedics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S David Gertz
- Institute for Research in Military Medicine (IRMM) and Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, POB 12272, 9112001, Jerusalem, Israel
- The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Oshrit Hoffer
- Department of Electrical Engineering, Afeka Tel-Aviv Academic College of Engineering, Tel-Aviv, Israel
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Bilateral muscle atrophy after anterior cruciate ligament reconstruction in rats: Protective effects of anti-inflammatory drug celecoxib. Knee 2022; 35:201-212. [PMID: 35381572 DOI: 10.1016/j.knee.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle atrophy after anterior cruciate ligament (ACL) reconstruction occurs bilaterally and contributes to a decrease in muscle strength. However, effective treatment strategies for ACL reconstruction-induced muscle atrophy have not been established. We examined the effects of anti-inflammatory drug on muscle atrophy after ACL reconstruction. MATERIALS AND METHODS Rats were divided into groups according to treatment received: untreated control (n = 4), arthrotomy (n = 6), ACL transection (n = 7), ACL reconstruction (n = 8), and ACL reconstruction plus anti-inflammatory drug celecoxib (CBX; 50 mg/kg/day) administration (n = 8). At one-week post-surgery, the muscle fiber cross-sectional area (CSA) in the rectus femoris (RF) and semitendinosus (ST) was measured to assess muscle atrophy. In addition, we examined joint swelling and serum C‑reactive protein (CRP) levels to assess local and systemic inflammation, respectively. RESULTS Each additional procedure (i.e., arthrotomy, ACL transection, and ACL reconstruction) gradually decreased the muscle fiber CSAs in the RF and ST on both operated and contralateral sides. The degree of muscle fiber atrophy on the operated side was larger than that detected on the contralateral side. Moreover, ACL reconstruction induced joint swelling on the operated side and tended to increase serum CRP levels. CBX lessened the RF atrophy on both sides and was associated with less joint swelling and a smaller increase CRP level; however, it did not affect ST atrophy on either side. CONCLUSIONS Anti-inflammatory treatments after ACL reconstruction may be effective in lessening muscle atrophy in the quadriceps, but not in the hamstrings.
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Preemptive Duloxetine Relieves Postoperative Pain and Lowers Wound Temperature in Centrally Sensitized Patients Undergoing Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Med 2021; 10:jcm10132809. [PMID: 34202314 PMCID: PMC8269433 DOI: 10.3390/jcm10132809] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/08/2023] Open
Abstract
(1) Background: The purpose of this study was to determine whether preemptive duloxetine in patients with central sensitization (CS) is effective for acute postoperative pain control and wound healing following total knee arthroplasty (TKA). (2) Methods: CS was defined as a score of 40 points or higher on the Central Sensitization Inventory (CSI) survey. Thirty-nine patients with CS were randomly assigned to either the duloxetine group (n = 19) or the placebo group (n = 20). The duloxetine group took duloxetine 30 mg once a day, while the placebo group took the placebo medication once a day. A pain visual analog scale (VAS) and the Brief Pain Inventory (BPI), wound complications, the temperature of the surgical site, and adverse events were investigated. Skin temperature was measured at the center of the patella using a portable digital thermometer. (3) Results: The duloxetine group reported significantly lower pain VAS scores during follow-up periods up to 6 weeks after surgery (all p < 0.05). BPI interference also showed significantly superior results in the duloxetine group after surgery (all p < 0.05). Although there was no difference in the rate of wound complications between the two groups (p > 0.05), the duloxetine group showed significantly lower wound temperature than the placebo group during the follow-up period (all p < 0.05). (4) Conclusion: In this study, preemptive duloxetine effectively reduced pain and lowered wound temperature following TKA in CS patients.
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Xiong Z, Cao S, Zhou L, Zhang X, Liu Q, Hu J, Liu F, Li Y. Intraoperative periarticular injection can alleviate the inflammatory response and enhance joint function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures. Medicine (Baltimore) 2021; 100:e24596. [PMID: 33607792 PMCID: PMC7899865 DOI: 10.1097/md.0000000000024596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study aimed to investigate the potential beneficial effects of periarticular injection (PAI) of multimodal drugs on the inflammatory response and joint function after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures. METHODS Fifty six elderly patients with unilateral osteoporotic femoral neck fractures were randomly allocated to 2 groups: the PAI group, which received the multimodal drug PAI intraoperatively before incision closure, and the control group, which received an injection of saline at the same time as placebo. The C-reactive protein (CRP), interleukin-1β (IL-1β), and IL-6 levels as well as the erythrocyte sedimentation rate (ESR) in peripheral venous blood samples were measured, along with the Visual Analogue Scale (VAS) score with activity and Harris hip score preoperation at 1, 2, 4, 7, and 14 days as well as 1 and 3 months post-operation. RESULTS The 2 groups were comparable in sex and age, and no significant differences were observed in the preoperative CRP, IL-1β, and IL-6 levels, ESR, VAS score, or Harris hip score between the 2 groups (all P > .05). However, during the postoperative period, the PAI group exhibited significantly lower levels of CRP, IL-1β, and IL-6 as well as a lower ERS and VAS score compared with the control group (P < .05), while the Harris hip score was significantly higher postoperatively in the PAI group (P < .05). CONCLUSION Multimodal drug PAI can alleviate the inflammatory response and enhance hip function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures.
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Affiliation(s)
- Zhizheng Xiong
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Shuai Cao
- Department of Orthopaedics, Second Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Lingling Zhou
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Xu Zhang
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Qi Liu
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Jinxi Hu
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Fang Liu
- Department of Orthopaedics, Second People's Hospital of Yueyang
- Yueyang Hospital Affiliated to Hunan Normal University, Hunan, PR China
| | - Yongwei Li
- Department of Orthopaedics, Second Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
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