Abstract
ObjectivesQuadriceps weakness (QW) following total knee arthroplasty (TKA) can be elicited by tourniquet-induced ischaemia reperfusion (IR), which causes a vigorous acute inflammatory response. Dietary n-3 polyunsaturated fatty acids (PUFA) are important determinants of organ and tissue protection from IR. This study aimed to examine the association between serum n-3 PUFA levels and QW, knee pain, and knee swelling immediately after TKA.MethodsA total of 32 patients who underwent unilateral TKA participated in this prospective study. On Postoperative Day 1, serum n-3 PUFA (eicosapentaenoic acid and docosahexaenoic acid) levels were measured. Preoperatively and on Postoperative Day 4, quadriceps strength, knee pain during quadriceps testing, and knee circumference were measured. QW, knee pain, and knee swelling were defined as changes in quadriceps strength, knee pain during quadriceps testing, and knee circumference, respectively, between the preoperative to the postoperative measurement.ResultsMean serum n-3 PUFA levels were 192 μg/mL (standard deviation, 58 μg/mL) on Postoperative Day 1. All measured variables changed significantly between the preoperative and the postoperative measurement time-points (P <0.01). Quadriceps strength decreased from 1.2 to 0.4 Nm/kg (QW = −65%). Knee pain during quadriceps testing increased from 1.1 to 6.0 (knee pain = 4.0). Knee circumference increased from 40 to 44 cm (knee swelling = 10%). Multivariate analysis showed that lower serum n-3 PUFA levels were independently associated with an increased QW after adjusting for the Kellgren-Lawrence grade and the tourniquet time (P = 0.04). No significant relationship was observed between serum n-3 PUFA levels and knee pain or knee swelling.ConclusionHigher serum n-3 PUFA are independently associated with a lower increase in the QW immediately after TKA.
Highlights
Total knee arthroplasty (TKA) is a common treatment for severe, painful knee osteoarthritis (OA)
No significant relationship was observed between serum n-3 polyunsaturated fatty acids (PUFA) levels and knee pain or knee swelling
This study focused on tourniquet-induced acute inflammation, including oxidative stress, which might occur after ischaemia reperfusion (IR) injury [16]
Summary
Total knee arthroplasty (TKA) is a common treatment for severe, painful knee osteoarthritis (OA). TKA reduces OA-related knee pain, recovery is often compromised by persistent lower extremity muscle weakness, leading to decreased functional performance [1,2]. In the early phase after TKA, quadriceps strength decreases to approximately 80% of its preoperative level [3]. Quadriceps weakness (QW) is associated with decreased gait speed, balance, chair rise and stair-climbing ability, and an increased risk of falls [4,5,6,7,8]. Postoperative deficits in quadriceps strength can be especially problematic and might exacerbate long-term weakness [9]. Treatment of TKA-induced QW is a significant challenge to improving postoperative recovery
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