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).
J Am Acad Orthop Surg Glob Res Rev. 2024 Mar 28;8(4). doi: 10.5435/JAAOSGlobal-D-23-00202. eCollection 2024 Apr 1.
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.
本次综述的主要目的是确定全膝关节置换术（TKA）后炎症反应（PIR）的减轻是否会显著改善临床结果评分。本次综述的次要目的是确定使用炎症生物标志物、临床炎症评估和影像学来量化 PIR 的最佳方法。使用预定的搜索策略对八个主要数据库进行了系统的文献检索。收集并以图形方式显示 C 反应蛋白（CRP）、白细胞介素 6（IL-6）、红细胞沉降率（ESR）、膝关节表面温度（KST）和临床结果数据。在报告治疗组炎症标志物有统计学显著下降的研究中，有 86%表明临床结果评分有显著改善。平均 CRP、IL-6、ESR 和 KST 值分别在术后第 2 天（POD2）、第 1 天（POD1）、第 7 天（POD7）和第 1-3 天（POD1-3）达到峰值。PIR 与早期疼痛和功能恢复结果相关。未来比较 TKA 手术方法和围手术期方案的研究应通过结合 CRP 和 IL-6 等炎症生物标志物以及临床炎症评估辅助手段来评估 PIR，以提供更全面的比较。
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