Computer-Assisted Surgery is Associated with Reduced Inflammatory Response in Total Knee Arthroplasty: A Randomized Double-Blinded Control Trial

Objectives: Total knee arthroplasty (TKA) is a standard treatment for advanced knee osteoarthritis (OA), but intramedullary reaming used in conventional (CON)-TKA may increase surgical trauma, blood loss, and systemic inflammation. Computer-assisted surgery (CAS)-TKA avoids canal entry and may reduce these adverse effects. This study compared postoperative inflammatory markers between CON-TKA and CAS-TKA. Methods: The study was approved by the Institutional Review Board on September ۲۵, ۲۰۱۹ (COA no. ۱۶۱/۶۱). Participants were recruited from May ۲۰۱۹ to August ۲۰۲۰, and the trial was retrospectively registered with the Thai Clinical Trials Registry on February ۲۴, ۲۰۲۱ (TCTR۲۰۲۱۰۲۲۴۰۰۷). Forty patients with primary knee OA (mean age ۶۷ years) were randomly assigned to CON-TKA or CAS-TKA. Serum inflammatory markers—interleukin-۶, C-reactive protein, and erythrocyte sedimentation rate (sIL-۶, sCRP, ESR)—were collected at baseline and at ۲۴ h, ۷۲ h, and ۲ weeks after surgery. Synovial markers (jIL-۶, jCRP) were obtained intraoperatively and from Hemovac drainage at ۲۴ h. Functional outcomes were assessed using the Knee Osteoarthritis Outcome Score (KOOS) at ۲ weeks. Results: The sIL-۶ and sCRP levels and ESR at ۲۴ h, ۷۲ h, and ۲ weeks after surgery were significantly elevated compared with those at baseline. The CAS-TKA group had a significantly lower change in the sIL-۶ and ESR at ۲ weeks than the CON-TKA group (۵.۳ ± ۲.۹ vs ۷.۹ ± ۴.۸, P = ۰.۰۴۰, and ۳۵ ± ۱۶ vs ۵۱ ± ۲۲, P = ۰.۰۱۳). Synovial marker levels did not significantly differ between the two groups. Further, there were no significant differences in KOOS at ۲ weeks between the two groups. Conclusion: Compared with CON-TKA, CAS-TKA had a lower inflammatory response and a smaller change in sIL-۶ and ESR levels at ۲ weeks after surgery. However, its functional benefits should be further investigated.         Level of evidence: I

کلیدواژه ها:

Computer-assisted surgery ، Inflammatory Marker ، Inflammatory response ، Interleukin-۶ ، Total knee arthroplasty