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J Knee Surg 2025; 38(01): 013-021
DOI: 10.1055/s-0044-1790243
Original Article

Inflammatory Marker Changes Following Total Knee Arthroplasty for Rheumatoid Arthritis with Vancomycin-Loaded Calcium Sulfate Bone Filling

Han Zhang   *
1   Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
,
Xiao Ma   *
1   Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
,
GuanHong Chen
2   Department of Orthopedics, Shanxian Central Hospital, Shandong Province, China
,
Ze Wang
3   Department of Neurology, Qingdao Haici Hospital, Qingdao, China
,
Zhen Shang
1   Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
,
Tianrui Wang
1   Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
,
Tengbo Yu
4   Department of Orthopedics, Qingdao Municipal Hospital, Qingdao, China
,
Yongtao Zhang
1   Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
› Institutsangaben
Funding Funding for this study was provided by the Shandong Provincial Natural Science Foundation, China [grant number ZR2021MH090] and Supported by Qingdao Outstanding Health Professional Development Fund.
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Abstract

Rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) face infection risk. The study evaluates vancomycin-loaded calcium sulfate bone as infection prevention. Patients with RA treated with TKA who had their femoral canal filled using either vancomycin-loaded calcium sulfate bone (experimental group [n = 35]) or the patient's own excised autologous bone (control group [n = 30]) at the Qingdao University Affiliated Hospital, Qingdao, China from January 1, 2017, to March 1, 2023, were retrospectively enrolled in this study. An experienced surgeon used midvastus approach. Surgeries included disinfection, antibiotics, and femoral filling. The age, gender, body mass index (BMI), comorbidities, and intraoperative details were extracted from the patient's medical records. Preoperation and postoperation markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]), pain scale (Visual Analog Scale [VAS]), infection rate, and Knee Society Score (KSS) were collected. Groups matched in age, gender, and BMI. No preoperative inflammatory marker differences were observed. However, compared to the control group, the postoperative inflammatory markers were significantly lower in the experimental group at 1-week postsurgery (CRP: 40.80 ± 23.17 vs. 60.80 ± 43.12 mg/L, p = 0.021; ESR: 72.06 ± 17.52 vs. 83.87 ± 21.52 mm/h, p = 0.012) and at 1-month postsurgery (CRP: 15.63 ± 6.56 vs. 21.17 ± 13.16 mg/L, p = 0.032; ESR: 25.25 ± 20.44 vs. 38.40 ± 25.26 mm/h, p = 0.024). There were no significant differences in the VAS (2.79 ± 0.90 vs. 2.70 ± 0.84 score, p = 0.689) and KSS (64.31 ± 17.88 vs. 66.57 ± 12.36) at 1-month postsurgery. Experimental group: zero infections; control group: only one infection. Administering vancomycin and calcium sulfate during TKA in RA patients reduces postoperative inflammation, but does not significantly affect infection risk; further research may be necessary for validation.

Keywords

vancomycin - calcium sulfate - rheumatoid arthritis - total knee arthroplasty - inflammatory markers

Ethics Approval and Consent to Participate

The study was approved by the Institutional Review Board and the Research Center of Qingdao University Affiliated Hospital and obtained patient informed consent (protocol code QYFY WZLL 28171).


Consent for Publication

All authors agree to publish in your journal and to abide by all your journal's regulations without dispute and this data is all based on public databases.


Availability of Data and Materials

The data sets generated and analyzed during the current study are not publicly available due to the hospital's requirement to protect patient privacy but are available from the corresponding author on reasonable request.


Authors' Contributions

Conceptualization, Z.H. and M.X.; methodology, C.G.H.; software, Y.T.B.; validation, W.T.R., Y.T.B., and Z.Y.T.; formal analysis, Z.H.; investigation, M.X.; resources, Z.Y.T.; data curation, W.Z.; writing—original draft preparation, Z.H.; writing—review and editing, M.X.; visualization, S.Z.; supervision, W.T.R.; project administration, Y.T.B.; funding acquisition, Z.Y.T. All authors have read and agreed to the published version of the manuscript.


* These authors contributed equally to this work and share first authorship


Supplementary Material



Publikationsverlauf

Eingereicht: 20. Mai 2024

Angenommen: 13. August 2024

Artikel online veröffentlicht:
27. September 2024

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