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Determining the stress biomarker profile in patients undergoing total knee replacement and the relationship with outcome at 12 months

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Chawla, Amit, Paraoan, Vlad, Rabiu, Rasheed, Clark, Tamsyn, Powell, Sam, Grammatopoulos, Dimitris, Armitage, Charlotte, Penedo, Ana, Havard, Alwyn, Metcalfe, Andrew J., Barlow, Timothy and Khatri, Chetan (2019) Determining the stress biomarker profile in patients undergoing total knee replacement and the relationship with outcome at 12 months. The Knee, 26 (6). pp. 1379-1385. doi:10.1016/j.knee.2019.08.010 ISSN 0968-0160.

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Official URL: https://doi.org/10.1016/j.knee.2019.08.010

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Abstract

Background:
Total knee replacement (TKR) is the commonest joint arthroplasty procedure worldwide. Despite excellent outcomes, some studies have reported dissatisfaction in up to 20% of patients.

There is evidence of an association between the biochemical stress response to surgery and outcomes. The objective of this study is to describe the stress biomarker profile for TKR, and correlate this with patient outcomes.

Methods:
A prospective cohort study of 50 patients undergoing primary TKR was conducted. Serum IL-6, TNF-α, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were measured immediately pre- and post-operatively, and on Days 1 and 3. Follow-up questionnaires including the Oxford Knee Score (OKS) and EuroQol five dimensions (EQ-5D) were completed at 12-months.

Univariate analysis was completed using a linear regression model (p < 0.05).

Results:
Serum IL-6, NLR, and PLR all increased to Day 1 post-operatively, and decreased by Day 3. TNF-α values increased across all time points.

Statistical analysis found a significant negative correlation (r = − 0.414; p = 0.005) between pre-operative IL-6 and 12-month OKS. There was a significant positive correlation between pre-operative NLR and 12 month OKS (r = 0.272; p = 0.039) and 12 month EQ5D (r = 0.268; p = 0.043).

Conclusion:
This is the first study to describe the biochemical stress response to TKR. The results raise the potential for a pre-operative risk stratification tool for patients based on IL-6 and NLR measurements.

Further research should be conducted to explore the underlying mechanisms involved, and investigate interventions to reduce pre-operative physiological stress with a view to improving post-operative outcomes.

Item Type: Journal Article
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RD Surgery
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Total knee replacement -- Treatment, Biochemical markers -- Research, Patients -- Stress (Psychology)
Journal or Publication Title: The Knee
Publisher: Elsevier BV
ISSN: 0968-0160
Official Date: 1 December 2019
Dates:
DateEvent
1 December 2019Published
28 September 2019Available
26 August 2019Accepted
Volume: 26
Number: 6
Page Range: pp. 1379-1385
DOI: 10.1016/j.knee.2019.08.010
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
Date of first compliant deposit: 12 November 2019
Date of first compliant Open Access: 28 September 2020
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
Research and Development FundUniversity of Warwickhttp://dx.doi.org/10.13039/501100000741

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