Risk factors associated with interleukin 6 level in serum after total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Shaoyun , CAO Guorui , HUANG Qiang , LEI Yiting , XU Hong ,  PEI Fuxing

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

PEI Fuxing, Email: peifuxinghx@163.com

Keywords：

Total knee arthroplasty; interleukin 6; risk factor; dexamethasone; tranexamic acid

DOI：

10.7507/1002-1892.201712011

Video：

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Objective To explore the risk factors associated with interleukin 6 (IL-6) level in serum after total knee arthroplasty (TKA). Methods A retrospective study was made on the clinical data of 273 patients underwent primary unilateral TKA between July 2015 and April 2017. There were 50 males and 223 females with an average age of 66.3 years (range, 36-89 years), and the body mass index (BMI) was (25.5±3.7) kg/m². Of them, 256 patients suffered with osteoarthritis, and the other 17 patients with rheumatoid arthritis. Univariate analysis was made to find the related factors between IL-6 level in serum at 1 day after operation and preoperative data including gender, age, BMI, diagnosis, comorbidities, preoperative American Society of Anesthesiologists (ASA) grade, preoperative varus or valgus deformity, range of motion of the knee, preoperative level of C-reactive protein (CRP) and IL-6 in serum, operation time, intraoperative blood loss, usage of drainage tube and catheter, and dosage of tranexamic acid and dexamethasone used on day of operation. Furthermore, the multiple linear regression analysis was performed to identify the risk factors. Results The operation time was (79.7±15.6) minutes, and the intraoperative blood loss was (107.8±25.3) mL. Drainage tubes were used in 111 patients and catheters were used in 41 patients after operation. The dosage of tranexamic acid and dexamethasone used on day of operation were (3.2±0.8) g and (15.1±6.6) mg, respectively. The levels of IL-6 in serum were (4.48±3.05), (42.65±37.09), and (28.21±26.44) pg/mL before operation and at 1 and 3 days after operation, respectively. Univariate analysis showed that the level of IL-6 in serum at 1 day after operation was significantly higher in variables as follows: age, diagnosis, history of lung infection, range of motion, preoperative levels of CRP and IL-6 in serum, intravenous dosage of tranexamic acid and dexamethasone on day of operation (P<0.05). Multiple linear regression analysis showed that range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were significant risk factors (P<0.05). Conclusion Range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were independent risk factors that resulted in increased level of IL-6 in serum at 1 day after TKA.

Citation： ZHANG Shaoyun, CAO Guorui, HUANG Qiang, LEI Yiting, XU Hong, PEI Fuxing. Risk factors associated with interleukin 6 level in serum after total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(8): 1001-1005. doi: 10.7507/1002-1892.201712011 Copy

1.	Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J, 1990, 265(3): 621-636.
2.	徐彬, 裴福興. 髖膝關節置換術加速康復中糖皮質激素的作用. 中華骨與關節外科雜志, 2017, 10(3): 259-264.
3.	Kugisaki H, Sonohata M, Komine M, et al. Serum concentrations of interleukin-6 in patients following unilateral versus bilateral total knee arthroplasty. J Orthop Sci, 2009, 14(4): 437-442.
4.	Xie JW, Ma J, Yao H, et al. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet: A Randomized Clinical Trial. J Arthroplasty, 2016, 31(11): 2458-2464.
5.	Ero?lu M, Kokulu S, Koca HB, et al. The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty. Eklem Hastalik Cerrahisi, 2016, 27(3): 153-159.
6.	Tsunoda K, Sonohata M, Kugisaki H, et al. The effect of air tourniquet on interleukin-6 levels in total knee arthroplasty. Open Orthop J, 2017, 11: 20-28.
7.	Xu B, Ma J, Huang Q, et al. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1549-1556.
8.	Yue C, Wei R, Liu Y. Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials. J Orthop Surg Res, 2017, 12(1): 100.
9.	Lunn TH, Kehlet H. Perioperative glucocorticoids in hip and knee surgery-benefit vs. harm? A review of randomized clinical trials. Acta Anaesthesiol Scand, 2013, 57(7): 823-834.
10.	Wegener JT, Kraal T, Stevens MF, et al. Low-dose dexamethasone during arthroplasty: What do we know about the risks? EFORT Open Rev, 2016, 1(8): 303-309.
11.	Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg (Am), 2012, 94(13): 1153-1159.
12.	Busuttil SJ, Ploplis VA, Castellino FJ, et al. A central role for plasminogen in the inflammatory response to biomaterials. J Thromb Haemost, 2004, 2(10): 1798-1805.
13.	Jimenez JJ, Iribarren JL, Lorente L, et al. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care, 2007, 11(6): R117.
14.	Lei YT, Xie JW, Xu B, et al. The efficacy and safety of multiple-dose intravenous tranexamic acid on blood loss following total knee arthroplasty: a randomized controlled trial. Int Orthop, 2017, 41(10): 2053-2059.
15.	Bin Abd Razak HR, Han XA, Chong HC, et al. Total knee arthroplasty in Asian subjects: preoperative range of motion determines postoperative range of motion? Orthop Surg, 2014, 6(1): 33-37.
16.	Farahini H, Moghtadaei M, Bagheri A, et al. Factors influencing range of motion after total knee arthroplasty. Iran Red Crescent Med J, 2012, 14(7): 417-421.
17.	孫仁剛, 楊黃. 高血壓病患者手術應激反應的年齡差異. 醫學文選, 2000, 19(2): 130-132.
18.	Kotake S, Sato K, Kim KJ, et al. Interleukin-6 and soluble interleukin-6 receptors in the synovial fluids from rheumatoid arthritis patients are responsible for osteoclast-like cell formation. J Bone Miner Res, 1996, 11(1): 88-95.
19.	Lisowska B, Maslinski W, Maldyk P, et al. The role of cytokines in inflammatory response after total knee arthroplasty in patients with rheumatoid arthritis. Rheumatol Int, 2008, 28(7): 667-671.
20.	Huang ZY, Shen B, Ma J, et al. Mini-midvastus versus medial parapatellar approach in TKA: muscle damage and inflammation markers. Orthopedics, 2012, 35(7): e1038-1045.
21.	Feng Y, Ju H, Yang B, et al. Effects of a selective cyclooxygenase-2 inhibitor on postoperative inflammatory reaction and pain after total knee replacement. J Pain, 2008, 9(1): 45-52.

1. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J, 1990, 265(3): 621-636.
2. 徐彬, 裴福興. 髖膝關節置換術加速康復中糖皮質激素的作用. 中華骨與關節外科雜志, 2017, 10(3): 259-264.
3. Kugisaki H, Sonohata M, Komine M, et al. Serum concentrations of interleukin-6 in patients following unilateral versus bilateral total knee arthroplasty. J Orthop Sci, 2009, 14(4): 437-442.
4. Xie JW, Ma J, Yao H, et al. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet: A Randomized Clinical Trial. J Arthroplasty, 2016, 31(11): 2458-2464.
5. Ero?lu M, Kokulu S, Koca HB, et al. The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty. Eklem Hastalik Cerrahisi, 2016, 27(3): 153-159.
6. Tsunoda K, Sonohata M, Kugisaki H, et al. The effect of air tourniquet on interleukin-6 levels in total knee arthroplasty. Open Orthop J, 2017, 11: 20-28.
7. Xu B, Ma J, Huang Q, et al. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1549-1556.
8. Yue C, Wei R, Liu Y. Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials. J Orthop Surg Res, 2017, 12(1): 100.
9. Lunn TH, Kehlet H. Perioperative glucocorticoids in hip and knee surgery-benefit vs. harm? A review of randomized clinical trials. Acta Anaesthesiol Scand, 2013, 57(7): 823-834.
10. Wegener JT, Kraal T, Stevens MF, et al. Low-dose dexamethasone during arthroplasty: What do we know about the risks? EFORT Open Rev, 2016, 1(8): 303-309.
11. Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg (Am), 2012, 94(13): 1153-1159.
12. Busuttil SJ, Ploplis VA, Castellino FJ, et al. A central role for plasminogen in the inflammatory response to biomaterials. J Thromb Haemost, 2004, 2(10): 1798-1805.
13. Jimenez JJ, Iribarren JL, Lorente L, et al. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care, 2007, 11(6): R117.
14. Lei YT, Xie JW, Xu B, et al. The efficacy and safety of multiple-dose intravenous tranexamic acid on blood loss following total knee arthroplasty: a randomized controlled trial. Int Orthop, 2017, 41(10): 2053-2059.
15. Bin Abd Razak HR, Han XA, Chong HC, et al. Total knee arthroplasty in Asian subjects: preoperative range of motion determines postoperative range of motion? Orthop Surg, 2014, 6(1): 33-37.
16. Farahini H, Moghtadaei M, Bagheri A, et al. Factors influencing range of motion after total knee arthroplasty. Iran Red Crescent Med J, 2012, 14(7): 417-421.
17. 孫仁剛, 楊黃. 高血壓病患者手術應激反應的年齡差異. 醫學文選, 2000, 19(2): 130-132.
18. Kotake S, Sato K, Kim KJ, et al. Interleukin-6 and soluble interleukin-6 receptors in the synovial fluids from rheumatoid arthritis patients are responsible for osteoclast-like cell formation. J Bone Miner Res, 1996, 11(1): 88-95.
19. Lisowska B, Maslinski W, Maldyk P, et al. The role of cytokines in inflammatory response after total knee arthroplasty in patients with rheumatoid arthritis. Rheumatol Int, 2008, 28(7): 667-671.
20. Huang ZY, Shen B, Ma J, et al. Mini-midvastus versus medial parapatellar approach in TKA: muscle damage and inflammation markers. Orthopedics, 2012, 35(7): e1038-1045.
21. Feng Y, Ju H, Yang B, et al. Effects of a selective cyclooxygenase-2 inhibitor on postoperative inflammatory reaction and pain after total knee replacement. J Pain, 2008, 9(1): 45-52.

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