Arzu ERDEN, Kübra CANLI, Murat EMİRZEOĞLU, Serap ÖZER YAMAN, İbrahim PEKŞEN, Osman AYNACI, Süleyman CANER KARAHAN, Ayhan PARMAKSIZ

TOTAL DİZ ARTROPLASTİ CERRAHİSİ GEÇİREN HASTALARIN CERRAHİ ÖNCESİ IL-1BETA, IL-6 VE TNFALPHA SEVİYELERİ CERRAHİ SONRASI FONKSİYONEL VE YAPISAL SONUÇLARINI ETKİLER Mİ?

Amaç: Serum sitokinleri osteoartritin semptomları ve progresyonu ile ilişkilidir. Bu sitokinlerin Total Diz Artroplastisi (TDA) sonrası semptomların şiddeti üzerinde tahmin edici bir etkisinin olup olmadığı bilinmemektedir. Bu çalışma cerrahi öncesi serum sitokin seviyelerinin (SSS) hastanede kalış, cerrahi sonrası ağrı şiddeti, fonksiyonel durum, eklem pozisyon hissi ve X-ray deki değişim üzerine etkisini göstermek amacıyla gerçekleştirildi. Yöntem: Evre 4 osteoartriti olan yirmi dokuz hasta çalışmaya dahil edildi. Cerrahi öncesi SSS (IL-6, TNF-alfa, IL-1beta) değerlendirildi. İstirahat/aktivite ağrı şiddeti ve alt ekstremite dizilim düzgünlüğü cerrahi öncesi, cerrahi sonrası 72. saat ve 6. haftada değerlendirildi. Fonksiyonel durum ve eklem pozisyon hissi cerrahi öncesi ve cerrahi sonrası 6. haftada değerlendirildi. Hastanede kalış süresi kaydedildi. Sonuçlar: Bireylerin yaş ortalaması 67,55±6,55 yıldı. Hastane kalış süresi ortalaması 6,48±3,06 gündü (en düşük:3, en yüksek:16). Cerrahi öncesi IL-6 ve TNF-alfa seviyeleri 6. haftada fonksiyonel durum ile negatif yönde koreleydi (r=0,46; p=0.01, r=0,39; p=0,03). Ayrıca, cerrahi öncesi TNF-alfa ve alt ekstremite dizilim düzgünlüğü arasında pozitif korelasyon vardı (r=0,39; p=0,04). Tartışma: Cerrahi öncesi daha düşük IL-6 ve TNF-alfa seviyesi olan osteoartritli hastalar cerrahi sonrası dönemde daha iyi fonksiyonel durum ve alt ekstremite düzgünlüğüne sahiptiler. Bu nedenle TDA cerrahisi zamanlamasına karar verebilmek için öncelikle SSS'nin azaltılması, cerrahi sonrası daha iyi bir biyomekanik gelişime neden olabilir. Cerrahi öncesi SSS hastane kalış süresi ile direk bağlantılı değildir.

Anahtar Kelimeler:

Artroplasti, Sitokin, Osteoartrit, Cerrahi Öncesi

DO PREOPERATIVE IL-1BETA, IL-6 AND TNF-ALPHA LEVELS OF PATIENTS WHO UNDERWENT TOTAL KNEE ARTHROPLASTY SURGERY AFFECT THE POSTOPERATIVE FUNCTIONAL AND STRUCTURAL RESULTS?

Purpose: Serum cytokines were associated with symptoms and progression of osteoarthritis. It is unknown whether these cytokines have a predictive role on the severity of symptoms after total knee arthroplasty (TKA) or not. This study was performed to investigate the effect of preoperative Serum Cytokine Levels (SCL) on length of stay in hospital (LOS), postoperative pain intensity, functional status, joint position sense, and change in X-ray. Methods: Twenty-nine patients with Grade 4 osteoarthritis degeneration level were included in the study. SCL (IL-6, TNF-alpha, IL-1beta) were assessed before surgery. Pain intensity at rest/activity and lower limb alignment were evaluated preoperative, postoperative 72nd hour and 6th week. Functional status and joint position sense were assessed before surgery and 6 weeks after surgery. Length of stay in hospital was also recorded. Results: The mean age of the participants was 67.55±6.55 years. The length of stay in the hospital mean was 6.48±3.06 day (min:3, max:16 days). Preoperative IL-6 and TNF-alpha level negatively correlated with functional status in the 6th week after surgery (r=0.46; p=0.01, r=0.39; p=0.03). Also, there was a positive correlation between preoperative TNF-alpha and the lower limb alignment at the 6th week after surgery (r=0.39; p=0.04). Conclusion: Patients with osteoarthritis who had lower preoperative IL-6 and TNF-alpha levels had better functional status and better lower limb alignment in the postoperative period. So in order to decide TKA surgery timing, primarily decreasing SCL might be caused better biomechanical development after surgery. Preoperative SCL was not directly related to the length of stay in the hospital.

Keywords:

Arthroplasty, Cytokine, Osteoarthritis, Preoperative.,

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