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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
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WRAP-determining-stress-biomarker-profile-patients-undergoing-total-knee-replacement-relationship-outcome-12 months-Metcalfe-2019.pdf - Accepted Version - Requires a PDF viewer. Download (1145Kb) | Preview |
Official URL: https://doi.org/10.1016/j.knee.2019.08.010
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 | ||||||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Biomedical Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Medicine > Warwick Medical School |
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| 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: |
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| 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 | ||||||||
| RIOXX Funder/Project Grant: |
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