Blood cytokine pattern and clinical outcome in knee arthroplasty patients: comparative analysis 5 years after standard versus "hypoallergenic" surface coated prosthesis implantation

Abstract

Background and purpose - Metal sensitivity might provoke complications after arthroplasty. Correspondingly, coated "hypoallergenic" implants are of interest but long-term follow-up data are missing. Thus, we assessed immunological and clinical parameters in such patients. Patients and methods - 5 years' follow-up data were obtained from 3 centers, which used either a standard total knee replacement (TKR) or the identical implant with multilayer surface zirconium nitride based coating. Of the 196 patients (mean age 68 years (44-84), 110 females) 97 had arthroplasty with a coated surface, and 99 were treated by a standard TKR of the same type. Investigations were Knee Society Score (KSS), Knee injury and Osteoarthritis Outcome Score (KOOS), radiographic analysis, and cytokine measurement in peripheral blood. Pro- and anti-inflammatory cytokines were evaluated by cytometric beads assay and RT-PCR. Results - Survival rate (Kaplan-Meier) was 98% for coated and 97% for uncoated implants after 5 years. Mechanical axis and KSS pain score (42 vs. 41 (0-50)) were comparable. Most serum cytokine levels were comparable, but mean interleukin-8 and interleukin-10 levels were higher in the group with an uncoated implant. IL-8: 37 (SD 7.5) pg/mL vs. 1.1 (SD 4.3) (p < 0.001); IL-10: 3.6 (SD 2.5) vs. 0.3 (SD 1.8) pg/mL (p < 0.001). Interpretation - There was similar clinical outcome 5 years after standard and surface-coated TKR. In peripheral blood there was an increased pro-inflammatory status, i.e., significant elevation of IL-8 and the anti-inflammatory IL-10, after standard uncoated prosthesis. Any long-term effects of these cytokine changes are unknown.

Figure 1

(left panel) Serum cytokine levels in patients with the uncoated (n = 98) and coated (n = 92) TKR (e.motion/e.motion-AS). (right panel) Serum cytokine levels in 20 patients prior to primary arthroplasty (“preoperative”) and 20 healthy individuals without implant (“controls”). The cytokines IL8, IL-6, the immunoregulatory IL-10, and the T-cell chemoattractant CXCL10 were assessed. Concentrations are given in pg/mL. ^b p < 0.01; ^c p < 0.001; standard deviation is given.

Figure 2

Relative expression levels of mRNA for IL-10 and IL-8 in peripheral blood of patients with the uncoated (n = 98) and coated (n = 92) TKR (e.motion/e.motion-AS). ^c p < 0.001; standard deviation is given. NS: not significant.