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

Abstract

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. The study was approved by the Institutional Review Board on September 25, 2019 (COA no. 161/61). Participants were recruited from May 2019 to August 2020, and the trial was retrospectively registered with the Thai Clinical Trials Registry on February 24, 2021 (TCTR20210224007). Forty patients with primary knee OA (mean age 67 years) were randomly assigned to CON-TKA or CAS-TKA. Serum inflammatory markers-interleukin-6, C-reactive protein, and erythrocyte sedimentation rate (sIL-6, sCRP, ESR)-were collected at baseline and at 24 h, 72 h, and 2 weeks after surgery. Synovial markers (jIL-6, jCRP) were obtained intraoperatively and from Hemovac drainage at 24 h. Functional outcomes were assessed using the Knee Osteoarthritis Outcome Score (KOOS) at 2 weeks. The sIL-6 and sCRP levels and ESR at 24 h, 72 h, and 2 weeks after surgery were significantly elevated compared with those at baseline. The CAS-TKA group had a significantly lower change in the sIL-6 and ESR at 2 weeks than the CON-TKA group (5.3 ± 2.9 vs 7.9 ± 4.8, P = 0.040, and 35 ± 16 vs 51 ± 22, P = 0.013). Synovial marker levels did not significantly differ between the two groups. Further, there were no significant differences in KOOS at 2 weeks between the two groups. Compared with CON-TKA, CAS-TKA had a lower inflammatory response and a smaller change in sIL-6 and ESR levels at 2 weeks after surgery. However, its functional benefits should be further investigated.