Tanavalee A, Honsawek S, Rojpornpradit T, Sakdinakiattikoon M, Ngarmukos S
Department of Orthopaedics, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
J Bone Joint Surg Br. 2011 Aug;93(8):1065-70. doi: 10.1302/0301-620X.93B8.26719.
We compared inflammation in the knee after total knee replacement (TKR) for primary osteoarthritis between two groups of patients undergoing joint replacement with and without synovectomy. A total of 67 patients who underwent unilateral TKR were randomly divided into group I, TKR without synovectomy, and group II, TKR with synovectomy. Clinical outcomes, serial serum inflammatory markers (including interleukin-6 (IL-6), CRP and ESR) and the difference in temperature of the skin of the knee, compared with the contralateral side, were sequentially evaluated until 26 weeks after surgery. Pre-operatively, there were no statistically different clinical parameters between groups I and II. At the 26-week follow-up, both groups had a similarly significantly improved American Knee Society clinical score (p < 0.001) and functional score (p < 0.001) with no differences between the groups. Similar changes in serial inflammatory markers were found in both groups, including mean peak levels of IL-6 (189 pg/ml (SD 53.4) versus 201 pg/ml (SD 49.4) for groups I and II, respectively) and CRP (91 mg/L (SD 24.1) versus 88 mg/L (SD 23.4), respectively) on the first post-operative day, returning to pre-operative values at two and six weeks, respectively. The mean peak level of ESR for the respective two groups was 46 mm/hr versus 48 mm/hr at two weeks, which had still not returned to its pre-operative mean value at 26 weeks. The elevation in the skin temperature appeared to mirror the peak elevation of the ESR, with a range of 2.5° C to 4.5° C with some reduction at 26 weeks but still exceeding the pre-operative value. We concluded that synovectomy at the time of TKR does not provide any benefit to the clinical outcome or shorten the duration of the inflammatory response after surgery.
我们比较了两组接受全膝关节置换术（TKR）治疗原发性骨关节炎患者的膝关节炎症情况，一组接受关节置换术时未进行滑膜切除术，另一组进行了滑膜切除术。共有67例行单侧TKR的患者被随机分为I组（未行滑膜切除术的TKR组）和II组（行滑膜切除术的TKR组）。依次评估临床结局、系列血清炎症标志物（包括白细胞介素-6（IL-6）、CRP和ESR）以及与对侧相比膝关节皮肤温度的差异，直至术后26周。术前，I组和II组之间的临床参数无统计学差异。在26周随访时，两组的美国膝关节协会临床评分（p < 0.001）和功能评分（p < 0.001）均有相似的显著改善，两组之间无差异。两组的系列炎症标志物出现相似变化，包括术后第一天IL-6的平均峰值水平（I组和II组分别为189 pg/ml（标准差53.4）和201 pg/ml（标准差49.4））和CRP（分别为91 mg/L（标准差24.1）和88 mg/L（标准差23.4）），分别在术后两周和六周恢复到术前值。两组各自的ESR平均峰值水平在两周时分别为46 mm/hr和48 mm/hr，在26周时仍未恢复到术前平均值。皮肤温度升高似乎与ESR的峰值升高情况一致，范围为2.5°C至4.5°C，在26周时有所下降，但仍超过术前值。我们得出结论，TKR时进行滑膜切除术对临床结局没有任何益处，也不会缩短术后炎症反应的持续时间。
