Inflammatory biomarkers and functional biomechanics of older adults with osteoartheritis before and after total knee arhroplasty

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Title Inflammatory biomarkers and functional biomechanics of older adults with osteoartheritis before and after total knee arhroplasty
Publication Type dissertation
School or College College of Engineering
Department Biomedical Engineering
Author Smith, Jessica Wynne
Date 2013-12
Description By the year 2030, there is expected to be a 6-fold increase in the number of annual total knee arthroplasty (TKA) surgeries. The growing demand for TKA has highlighted the need to develop improved measures for identifying modifiable factors that may be linked to poor physical performance and long-term outcomes following TKA. This body of work focuses on factors that may be linked to poor TKA outcomes, including the following: 1) physiological factors such as high sensitivity C-reactive protein (hs-CRP) and cytokines and 2) post-TKA functional outcomes that may be linked to future mobility deficits and risk of falling. A total of 47 subjects with osteoarthritis (OA) scheduled for TKA, and 11 controls without OA were assessed in two separate clinical studies. Study #1 encompassed 31 TKA subjects stratified by hs-CRP: 15 with hs-CRP <1.0 mg/L and 16 with hs-CRP >4.0 mg/L. Study #2 included 16 subjects with OA scheduled for TKA and 11 controls without OA. In Study #1, synovial fluid (SF) and bone sections were sequestered during surgery; 12 cytokines were measured in SF and histological measures of inflammation were assessed in bone sections. Relationships between cytokines and hs-CRP were assessed. In Study #2, pre- and postoperative assessments of submaximal muscle force steadiness (MFS) and variability during gait and stair stepping were evaluated and compared to healthy controls. Study #1 showed the presence of lymphocytes in 10 synovium and one bone sample (all from high hs-CRP group), and significant correlations between hs-CRP and cytokines interleukin (IL)-5 and IL-10. Study #2 showed that quadriceps MFS was significantly more impaired in the TKA subjects preoperatively, but not postoperatively compared to controls, and significantly improved between the pre- and postoperative visits. Additionally, there was a significant reduction in variability during gait between pre- and postoperative visits, but not during stair stepping. The results suggest that inflammatory mechanisms contribute to OA progression, with hs-CRP being a possible predictive variable, combined with other comorbidities, of postoperative function. Further, postoperative functional measures such as MFS and variability during gait and stair stepping may provide rehabilitation targets for individuals following TKA that may predict future falls and declines in functional mobility.
Type Text
Publisher University of Utah
Subject Biomechanics; Inflammation; Older adults; Osteoarthritis; Total knee arthroplasty
Dissertation Institution University of Utah
Dissertation Name Doctor of Philosophy
Language eng
Rights Management Copyright © Jessica Wynne Smith 2013
Format application/pdf
Format Medium application/pdf
Format Extent 1,252,939 bytes
Identifier etd3/id/2686
ARK ark:/87278/s6qv6vqp
Setname ir_etd
ID 196261
Reference URL https://collections.lib.utah.edu/ark:/87278/s6qv6vqp
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