Effects of Navigation Versus Conventional Total Knee Arthroplasty on the Levels of Inflammation Markers
Effects of Navigation Versus Conventional Total Knee Arthroplasty on the Levels of Inflammation Markers
Total knee arthroplasty (TKA) is a well-established modality for the treatment of advanced
 knee osteoarthritis with high satisfaction rate. However, the traditional cutting jigs for
 distal femur cutting inevitably violates the medullary canal of femoral bone. The process of
 intramedullary reaming for the insertion of distal femur cutting jigs stimulated the
 dissipation of marrow emboli that reported lead to increased risk of myocardial infarction or
 cardiac stress perioperatively. There are emerging refinements aiming to reduce the insult to
 the medullary canal of the distal femur as well as to improve the prosthetic alignment, such
 as navigation assisted TKA or robotic surgery.

 In addition to better prosthetic alignment, computer-assisted navigation TKAs also mitigate
 perioperative blood loss and systemic emboli. The publication previously published by the
 investigators showed that navigation TKAs can lead to lesser extent of elevation of
 endothelial injury markers than the traditional TKAs. However, the detrimental effects of
 intramedullary reaming seem to be multi-dimensional and the whole picture has not been
 elucidated clearly at present.

 Previous studies have shown that operative trauma can trigger marked immune responses.
 Operative procedures can simultaneously stimulate the pro-inflammatory and anti-inflammatory
 response, with 80% of the leucocyte transcriptome being affected. Most studies of hip or knee
 surgery found that operation-triggered immune reactions are associated with postoperative
 recovery, infection, and even mortality.

 The navigation TKAs avoid the process of intra-medullary reaming, which is the mandatory part
 of conventional TKA for the distal femur cutting. The investigators hypothesize that the
 reaming process may exert substantial inflammatory response, which can be manifested by
 higher level of inflammatory markers in the serum and hemovac drainage samples obtained from
 the participants undergoing conventional TKAs.
Inclusion Criteria:

 -  end stage knee OA necessitating TKR surgeries

 Exclusion Criteria:

 -  autoimmune diseases, malignancies, previous knee surgery or post-traumatic arthritis