Abstract
Introduction
Total Knee Arthroplasty (TKA) aims to deliver relief from pain and restore normal function. Unfortunately, a significant cohort of patients report poor outcomes.
Hypothesis
Synovial fluid metabolite concentrations at surgery predict outcome of TKA, assessed by a validated measure.
Methods
Synovial fluid was taken from six patients undergoing TKR immediately prior to surgery. After centrifugation to remove cells and addition of 0.5% TSP in D2O. 1H Nuclear Magnetic Resonance (NMR) Spectroscopy was performed on the acellular fluid. In-house software identified peaks of selected metabolites of interest and computed metabolite concentration. Concentrations were analysed in relation to Oxford Knee Score (OKS), performed for all patients at a minimum of 6 months post-operatively. Patients were segregated into two groups based on OKS: Good (> 25) and Poor (< 25) and ANOVA used to determine whether specific metabolites significantly associated with TKR outcome.
Results
We found a significantly higher mean concentration of Alanine (P < 0.05) in patients with well-functioning TKR (0.085M SE ± 0.062) compared with those with poor outcomes (0.014M SE ± 0.002). Other variances in mean concentration were observed, but were not significant.
Discussion
Though the reasons for poor outcomes of TKR are not fully understood, it is likely that the joint environment has a role to play. The role of Alanine in this case is not clear. Further prospective analysis in a larger cohort may yield significant differences in other metabolites.
Significance
Our approach could help to inform clinicians and patients further about likely outcomes.
