Systemic effects of polymethylmethycrylate in total knee replacement: A prospective case-control study

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Immunology

Background:

• National Joint Registry data indicates higher mortality with cemented total knee replacement (TKR).
• Systemic inflammatory responses, endothelial dysfunction, and coagulation activation are critical post-TKR.
• Understanding these responses is key to improving patient outcomes and surgical techniques.

Purpose of the Study:

• To compare the systemic inflammatory, endothelial, and coagulation responses to cemented versus uncemented TKR.
• To investigate the activation of specific inflammatory markers and cytokines following both types of TKR procedures.

Main Methods:

• A prospective, case-control study involving 38 patients (19 cemented, 19 uncemented TKR).
• Blood samples collected pre-operatively, and at 24 hours and 7 days post-operatively.
• Analysis of serum markers including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNFα), CD40, and CD14/42a.

Main Results:

• No significant differences in CRP, IL-6, or TNFα levels between cemented and uncemented TKR groups.
• CD40 levels increased significantly in the cemented group from day 1 to day 7, whereas the uncemented group showed an increase within the first 24 hours.
• CD14/42a levels significantly increased in the cemented group at both 24 hours and between days 1 and 7.

Conclusions:

• Apart from CD14/42a levels, no significant differences were observed in systemic markers of inflammation, coagulation, or endothelial dysfunction between cemented and uncemented TKR.
• The study provides insights into the nuanced systemic responses following different TKR fixation methods.
• Further research may elucidate the clinical significance of the observed differences in CD40 and CD14/42a levels.