Effect of Celecoxib on Surgical Site Inflammation after Total Knee Arthroplasty: A Randomized Controlled Study

Abstract

Objective: To evaluate the anti-inflammatory effectiveness of celecoxib and its effect on the rehabilitation of joint function after total knee arthroplasty.

Methods: 72 patients presented between 2016 and 2017 and were divided into two groups. The experimental group was given 200 mg celecoxib twice daily with tramadol hydrochloride 50 mg twice daily (as required); the control group was given tramadol hydrochloride 50 mg twice daily for 6 weeks from the first day after total knee arthroplasty. Skin temperature around the knee was measured 1 day before surgery, on postoperative days 1 and 3, and at weeks 1, 2, and 6. Inflammatory markers (white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and interleukin-6) were measured preoperatively, on postoperative day 3, and at weeks 1 and 6. Knee Society Score was recorded preoperatively and at postoperative weeks 1, 2, and 6.

Results: Except for preoperative skin temperature, the recorded skin temperatures of the experimental group were significantly different compared to those of the control group (p = 0.001, 0.024, 0.030, 0.041, 0.047, respectively). Levels of C-reactive protein were significantly different at the 1st and the 6th week after surgery, differing by 19.3 ± 4.64 mg/L (p < 0.001) and 2.6 ± 0.92 mg/L (p = 0.006). Levels of interleukin-6 showed a significant difference of 6.61 ± 2.36 pg/mL (p = 0.007) at the 1st week after surgery. Until the 6th week after surgery, the erythrocyte sedimentation rate in the experimental group and the control group differed by 17 ± 4.6 mm/h (p = 0.001).

Conclusions: Celecoxib has a significant inhibitory effect on postoperative aseptic inflammation.

Keywords: Aseptic inflammatory reaction; Inflammation index; Selective COX-2 inhibitor; Total knee arthroplasty.

Fig. 1

Experimental design flow. Tramadol hydrochloride in both groups was given individually to ensure the patients can accept and complete a standardized rehabilitation exercise. The indices include white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 levels. PRN, as needed; ST, skin temperature; BID, twice daily; PO, oral; d, day; w, week.

Fig. 2

Skin temperatures on the affected side. Except for the preoperative skin temperature, the recorded skin temperatures of the experimental group had statistically significant differences as compared with those of the control group (** p < 0.01, * p < 0.05).

Fig. 3

Indices of inflammation. a WBC showed no significant differences at any point in the experiment. b Levels of CRP showed significant differences at the 1st week and at the 6th week after TKA (** p < 0.01, *** p < 0.001). c Levels of IL-6 were statistically different at the 1st week after surgery (** p < 0.01). d ESR levels were different only after 6th week after surgery (*** p < 0.001).

Fig. 4

The trend of the KSS. KSS were different at the 1st week after surgery (* p < 0.05).