Punit Abhinandan S, Sangani Karthik, Prashanth B N, Ismail Ihjas, Kumar S Satish
Narayana Healthcity Hospital, Bengaluru, 560099, Karnataka, India.
BMC Musculoskelet Disord. 2025 May 6;26(1):447. doi: 10.1186/s12891-025-08585-0.
Conventional Total Knee Arthroplasty (CTKA) has long been the standard for arthroplasty. Recent technological advancements have introduced Robot-Assisted Total Knee Arthroplasty (RATKA) and its more automated versions, such as active RATKA offering enhanced precision, accuracy, and potentially superior outcomes. Their role in inflammatory markers has been sparsely explored. Inflammatory response has a direct effect on functional recovery following joint replacement. Our study aimed to understand the natural progression of these inflammatory markers post-surgery. It compared the inflammatory response of CTKA and active RATKA to identify their differences. It also evaluated the role of comorbidities, gender, tourniquet usage, and unilateral or bilateral surgery on inflammatory markers.
CRP, IL6, ESR, and TLC were measured preoperatively, on postoperative day 2 (POD2), POD14, and POD30 in 192 consecutive cases of TKA.
CRP increased from 6.59 mg/ml(SD 4.92) preop to 190.57 mg/ml(SD 77.62) on POD2, then decreased to 53.55 mg/ml(SD 42.3) on POD14 and 16.72 mg/ml(SD 14.04) by POD30(p-0.001). ESR rose from 18.81 mm/hr(SD 7.17) preop to 62.78 mm/hr(SD 34.41) on POD2, with a decrease to 57.05 mm/hr(SD 26.63) on POD14 and 27.18 mm/hr(SD 22.42) by POD30(p-0.001). IL6 was markedly elevated at 163.60pg/ml(SD 51.05) on POD2 compared to 6.55pg/ml(SD 2.58) preop(p-0.001). The RATKA group had lower CRP, ESR, and TLC levels than CTKA (p < 0.05). Diabetes Mellitus was associated with increased inflammation (p < 0.05).
RATKA cases showed a lower inflammatory response in several markers and slightly better pain scores compared to the conventional approach. Factors such as tourniquet usage and patient gender did not significantly impact inflammatory markers. Among the comorbidities, Diabetes Mellitus increased inflammation. In the majority of the normal patients, the inflammatory markers did not return to the normal reference even 1 month post-surgery. This physiological variation should be considered when assessing for potential prosthetic joint infections.
传统全膝关节置换术（CTKA）长期以来一直是关节置换术的标准术式。最近的技术进步引入了机器人辅助全膝关节置换术（RATKA）及其更自动化的版本，如主动式RATKA，其具有更高的精度、准确性，并可能带来更优的手术效果。它们在炎症标志物方面的作用鲜有研究。炎症反应对关节置换术后的功能恢复有直接影响。我们的研究旨在了解这些炎症标志物术后的自然变化过程。比较CTKA和主动式RATKA的炎症反应以确定它们的差异。还评估了合并症、性别、止血带使用情况以及单侧或双侧手术对炎症标志物的作用。
对192例连续的全膝关节置换术患者在术前、术后第2天（POD2）、POD14和POD30测量了CRP、IL6、ESR和TLC。
CRP从术前的6.59mg/ml（标准差4.92）升至POD2时的190.57mg/ml（标准差77.62），然后在POD14时降至53.55mg/ml（标准差42.3），到POD三十时降至16.72mg/ml（标准差14.04）（p<0.001）。ESR从术前的18.81mm/hr（标准差7.17）升至POD2时的62.78mm/hr（标准差34.41），在POD14时降至57.05mm/hr（标准差26.63），到POD30时降至27.18mm/hr（标准差22.42）（p<0.001）。IL6在POD2时显著升高至163.60pg/ml（标准差51.05），而术前为6.55pg/ml（标准差2.58）（p<0.001）。RATKA组的CRP、ESR和TLC水平低于CTKA组（p<0.05）。糖尿病与炎症增加相关（p<0.05）。
与传统方法相比，RATKA病例在几种标志物中显示出较低的炎症反应，疼痛评分也略好。止血带使用情况和患者性别等因素对炎症标志物没有显著影响。在合并症中，糖尿病会增加炎症。在大多数正常患者中，即使术后1个月炎症标志物仍未恢复到正常参考值。在评估潜在的人工关节感染时应考虑这种生理变化。
