title: Alteration of inflammatory cytokine production in primary total knee arthroplasty using antibiotic-loaded bone cement.
abstract: BACKGROUND
  The aim was to compare serum levels of interleukin-6 (SIL6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and joint fluid IL-6 (JIL-6) level between total knee arthroplasty (TKA) that used bone cement (BC group) and antibiotic-loaded bone cement (ALBC group).
  
  
  METHODS
  Thirty-nine patients (40 TKAs) with a mean age of 69.6 years were non-randomly assigned to the BC or ALBC groups. Samples of SIL6, ESR, and CRP were collected at baseline and at 24 h, 72 h, and 4 weeks after surgery. JIL-6 levels were collected intraoperatively before joint arthrotomy, before finishing the procedure and 24 h after surgery. Postoperative mediator levels were compared with baseline levels within the same group and between groups at each time point. Knee Society Score-knee (KSSK) and Knee Society Score-function (KSSF) scores were evaluated.
  
  
  RESULTS
  SIL-6, ESR, and CRP levels were significantly elevated at 24 and 72 h, compared to baseline. Only SIL-6 levels at 72 h in the ALBC group showed a significantly lower level than those in the BC group. JIL-6 levels were not different between groups. There were no significant differences in KSSK or KSSF scores between groups at 4 weeks and the most recent follow-up (1.4 ± 0.6 years) evaluation. No correlations were identified among SIL-6 and JIL-6 levels at 24 and 72 h, and KSSK and KSSF scores at 4 weeks and at the most recent evaluation.
  
  
  CONCLUSIONS
  ALBC showed a favorable immunomodulatory effect and lower SIL-6 level at 72 h following TKA compared to BC, although functional benefits require further investigation.
  
  
  METHODS
  OCEBM, Level 3.
authors: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors: Vajara
authors: V
authors: Wilairatana
authors: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors: Peerasit
authors: P
authors: Sinlapavilawan
authors: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.|Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors: Sittisak
authors: S
authors: Honsawek
authors: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand. Noppachart.L@chula.ac.th.
authors: Noppachart
authors: http://orcid.org/0000-0002-7931-7857
authors: N
authors: Limpaphayom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D001799:Blood Sedimentation; D001843:Bone Cements / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000378:metabolism* / Q000601:surgery*; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; C508600:IL6 protein, human; D015850:Interleukin-6; C529143:Palacos R+G; D002097:C-Reactive Protein; D019904:Polymethyl Methacrylate
keywords: Assessment; Bone cements; C-reactive protein; Erythrocyte sedimentation rate; Inflammation; Interleukin-6; Knee arthroplasty; Patient outcome