Aim. The aim of this prospective comparative study was to evaluate the serum levels of different cytokines in patients underwent total knee replacement (TKR) and received allogeneic blood transfusion, post-operative auto-transfusion or not transfused. Material and Methods. This was a prospective non-randomized comparative study in 248 patients underwent TKR. Patient's demographic and clinical data including age, gender, body mass index (BMI), preoperative Hb value, complications were documented. The serum levels of IL-1b, IL-6, IL-8, IL-10, and TNF were measure pre-operatively, the 1st, 2nd, 3rd and 5th post-operative day. Patients were categorized in three groups; in Group 0 patients received no blood transfusion, in Group 1 patients received post-operative auto-transfusion and in Group 2 allogeneic blood transfusion was applied. Statistical analysis of the results was performed using repeated measures ANOVA. Results. Significant changes were observed in cytokines levels in Groups 1 and 2. In Group 1 (auto-transfusion) the levels of all cytokines significantly increased the 1st postoperative day, remaining above the pre-operative levels even the 5th post-operative day. In Group 2 (allogenic transfusion), although the levels of IL-6, IL-8 and IL-10 were also significantly increased the 1st postoperative day, they gradually returned to the per-operative levels by the 5th post-operative day. In Group 0 (no transfusion) the only significant increase was observed in IL-6 between pre-operative and 1st and 3rd day values. Furthermore, the area under the curve (AUC) of IL-1b, IL-6, IL-8 and IL-10 levels in Group 1 and AUC of IL-6, IL-8 and IL-10 levels in Group 2, were significantly higher compared to Group 0. There was no significant difference in post-operative patient's complications. Conclusion. According to the results of this study significant elevation of cytokine values were observed during the first five post-operative days in patients received blood transfusion after TKR. These changes were more pronounced in the auto-transfusion group

In a randomized study of 60 patients allergic reactions are evaluated in three joint prosthesis groups, a resurfacing arthroplasty (ReCap), a non-cemented, large metal-on-metal head (Bimetric Magnum) and a non-cemented, alumina ceramic-on-ceramic bearing in a titanium shell (Bimetric C2a). The inclusion criteria were osteoarthritis, ASA I–II, MRI-scan without caput necrosis, DXA-scan without osteoporosis. The exclusion criteria were short neck (<2cm.), large cysts (>1cm.), medical treatment affecting the bone metabolism, severe deformity of the femoral head, impaired kidney function and inability to co-operate. Blood samples were drawn prior to and 6 weeks, 6 months, 1 year, and 3 years after surgery; two tubes from which plasma was prepared, and two tubes for serum. From the last included 20 patients in each group was also taken blood one and three years after surgery for an in vitro lymphocyte assay for scoring of possible hypersensitivity to prosthesis metals. The isolated lymphocytes were subjected to measurement of proliferation and expression of CD69 by flow cytometry and measurement of the Migration Inhibitory Factor (MIF) by ELISA. Plasma concentrations of the cytokines IL-1, IL-4, IL-6, IL-8, IL-12p70, IL-15, interferon-and osteoprotegerin were determined by multiplex-immunoassay. Serum concentrations of chromium and cobalt were determined by graphite furnace atomic absorption spectrometry. The serum concentrations of chromium and cobalt were lowest in patients with the C2a implant and highest with Magnum, some of these differences were significant at 6 weeks, 6 months, and 1 year after surgery. No patient had a very high serum metal concentration. The values of the variables measured in the in vitro lymphocyte assay mainly changed in the expected direction depending on the concentration of the same metal in the serum sample drawn at the same time, but no significant correlation was seen. One patient had uncertain symptoms of metal hypersensitivity and relatively high serum metal concentrations 3 years after arthroplasty with a Magnum prosthesis and was assessed extraordinarily, and elicited the marginally highest MIF responses in the lymphocyte assay. A strong correlation was found between the plasma concentrations of most cytokines, but the cytokine concentrations were not correlated to contemporary metal concentrations