Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, United States.
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, United States.
Orthop Traumatol Surg Res. 2021 May;107(3):102870. doi: 10.1016/j.otsr.2021.102870. Epub 2021 Feb 24.
Current diagnostic criteria for arthrofibrosis are limited. Since many patients will be aspirated during their clinical course, synovial fluid analysis may supplement current diagnostic criteria for arthrofibrosis. The goal of this study was to determine a unique synovial fluid and inflammatory marker profile for diagnosing arthrofibrosis.
Patients with arthrofibrosis following total knee arthroplasty will have a unique synovial fluid aspirate profile compared to control patients to aid in diagnosis.
Between 2013 and 2017, 32 patients (32 total knee arthroplasties [TKAs]) underwent revision TKAs for arthrofibrosis. Fourteen patients had pre-revision aspirations. They were 2:1 matched based on age, sex, body mass index (BMI), and year of revision to 28 patients who underwent aseptic revision TKAs for reasons other than arthrofibrosis (control group). Mean age at revision was 66years, with 64% males.
In TKAs revised for arthrofibrosis, mean total cell count was 828cells/uL. These aspirates contained a mean distribution of 46% macrophages (range: 4-76%), 31% lymphocytes (range: 11-68%), 21% neutrophils (range: 0-75%), 1% other cells (mainly synovial cells; range: 0-11%), and 1% eosinophils (range: 0-7%). There was no significant difference in mean total cell count (p=0.8) or mean distribution of macrophages (p=0.6), lymphocytes (p=0.1), neutrophils (p=0.2), eosinophils (p>0.9), or serum inflammatory markers (p>0.7) when compared to controls. All aspirations were culture negative for infection.
The profile of arthrofibrotic synovial fluid aspirates and serum inflammatory marker values were similar to patients revised for non-arthrofibrotic aseptic etiologies. This suggests synovial fluid and serum inflammatory markers in non-infected knees with arthrofibrosis should expect to have characteristics similar to synovial fluid and inflammatory marker profiles in other aseptic diagnoses.
III; retrospective case-control study.
目前的关节纤维性僵直诊断标准存在局限性。由于许多患者在临床过程中需要进行关节穿刺，因此滑液分析可能有助于补充目前的关节纤维性僵直诊断标准。本研究的目的是确定一种独特的滑液和炎症标志物特征，以帮助诊断关节纤维性僵直。
与对照组患者相比，全膝关节置换术后发生关节纤维性僵直的患者的关节滑液抽吸特征将具有独特性，有助于诊断。
2013 年至 2017 年间，32 例（32 例全膝关节置换术[TKA]）患者因关节纤维性僵直接受了翻修 TKA。14 例患者在翻修前进行了关节穿刺。根据年龄、性别、体重指数（BMI）和翻修年份，他们与 28 例因非关节纤维性僵直原因接受无菌性翻修 TKA 的患者（对照组）进行了 2:1 配对。翻修时的平均年龄为 66 岁，64%为男性。
在因关节纤维性僵直而接受翻修的 TKA 中，平均总细胞计数为 828 个/μL。这些抽吸物中含有 46%的巨噬细胞（范围：4-76%）、31%的淋巴细胞（范围：11-68%）、21%的中性粒细胞（范围：0-75%）、1%的其他细胞（主要是滑膜细胞；范围：0-11%）和 1%的嗜酸性粒细胞（范围：0-7%）。与对照组相比，总细胞计数（p=0.8）或巨噬细胞（p=0.6）、淋巴细胞（p=0.1）、中性粒细胞（p=0.2）、嗜酸性粒细胞（p>0.9）的平均分布差异均无统计学意义或血清炎症标志物（p>0.7）。所有关节抽吸物的培养均为阴性，无感染。
关节纤维性僵直患者的滑液抽吸物特征和血清炎症标志物值与因非关节纤维性僵直无菌性病因而接受翻修的患者相似。这表明，患有非感染性关节纤维性僵直的膝关节的滑液和血清炎症标志物应与其他无菌性诊断的滑液和炎症标志物特征相似。
III；回顾性病例对照研究。
