Preoperative methylprednisolone increases plasma Pentraxin PTX3 early after total knee arthroplasty: a randomized, double-blind, placebo-controlled trial

Summary

Preoperative glucocorticoid administration reduces the systemic inflammatory response. Pentraxin-3 (PTX3) is a novel inflammatory marker belonging to the humoral arm of innate immunity exerting a potentially protective host response.

This study evaluated PTX3 and other complement marker changes after preoperative methylprednisolone (MP) early after total knee arthroplasty (TKA). Seventy patients were randomized (1:1) to preoperative intravenous (IV) MP 125 mg (group MP) or isotonic saline IV (group C). The outcomes included change in plasma PTX3, Mannose-binding lectin (MBL), Ficolins (Ficolin-1, -2 and -3), Complement components (C4 and C3), Terminal complement complex (TCC) and C-reactive protein (CRP) concentrations. Blood samples were analysed at baseline and 2, 6, 24 and 48 hours after surgery with complete sampling from 63 patients for analyses.

MP resulted in an increase in circulating PTX3 compared to saline from baseline to 24 hours postoperatively (p<0.001), while MP reduced the systemic inflammatory response (CRP) 24 and 48 hours postoperatively (p<0.001). However, the small postoperative changes in MBL, Ficolin-1, -2 and -3, C4, C3 and TCC concentrations did not differ between groups (p>0.05).

In conclusion, preoperative MP 125 mg increased circulating PTX3 and reduced the general inflammatory response (CRP) early after TKA, but did not affect other complement markers. This article is protected by copyright. All rights reserved.