Better post-operative outcomes at 1-year follow-up are associated with lower levels of pre-operative synovitis and higher levels of IL-6 and VEGFA in unicompartmental knee arthroplasty patients

Abstract

Purpose Osteoarthritis (OA) is associated with infammation, and residual infammation may infuence outcomes following knee arthroplasty. This may be more relevant for patients undergoing unicompartmental knee arthroplasty (UKA) due to larger remaining areas of native tissue. This study aimed to: (1) characterise infammatory profles for medial UKA patients and (2) investigate whether infammation markers are associated with post-operative outcomes. Methods This prospective, observational study has national ethics approval. Bloods, synovial fuid, tibial plateaus and synovium were collected from medial UKA patients in between 1 January 2021 and 31 December 2021. Cytokine and chemokine concentrations in serum and synovial fuid (SF) were measured with multiplexed assays. Disease severity of cartilage and synovium was assessed using validated histological scores. Post-operative outcomes were measured with Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12) and pain scores. Results The study included 35 patients. SF VEGFA was negatively correlated with pre-operative pain at rest (r − 0.5, p=0.007), and FJS-12 at six-week (r 0.44, p=0.02), six-month (r 0.61, p<0.01) and one-year follow-up (r 0.63, p=0.03). Serum and SF IL-6 were positively correlated with OKS at early follow-up (serum 6 weeks, r 0.39, p=0.03; 6 months, r 0.48, p<0.01; SF 6 weeks, r 0.35, p=0.04). At six weeks, increased synovitis was negatively correlated with improvements in pain at rest (r − 0.41, p=0.03) and with mobilisation (r − 0.37, p=0.047). Conclusion Lower levels of synovitis and higher levels of IL-6 and VEGFA were associated with better post-operative outcomes after UKA, which could be helpful for identifying UKA patients in clinical practice. Level of evidence Level IV case series.