Date Published: June 4, 2012
Publisher: Informa Healthcare
Author(s): Olof Sandberg, Pernilla Eliasson, Therese Andersson, Fredik Agholme, Per Aspenberg.
Should blockade of TNF-α be avoided after orthopedic surgery? Healing of injuries in soft tissues and bone starts with a brief inflammatory phase. Modulation of inflammatory signaling might therefore interfere with healing. For example, Cox inhibitors impair healing in animal models of tendon, ligament, and bone injury, as well as in fracture patients. TNF-α is expressed locally at increased levels during early healing of these tissues. We therefore investigated whether blocking of TNF-α with etanercept influences the healing process in established rat models of injury of tendons and metaphyseal bone.
Rats were injected with etanercept, 3.5 mg/kg 3 times a week. Healing of transected Achilles tendons and bone healing around screws implanted in the tibial metaphysis were estimated by mechanical testing. Tendons were allowed to heal either with or without mechanical loading. Ectopic bone induction following intramuscular BMP-2 implants has previously been shown to be stimulated by etanercept in rodents. This was now tested as a positive control.
Tendon peak force after 10 days was not significantly influenced by etanercept. Changes exceeding 29% could be excluded with 95% confidence. Likewise, screw pull-out force was not significantly influenced. More than 25% decrease or 18% increase could be excluded with 95% confidence. However, etanercept treatment increased the amount of bone induced by intramuscular BMP-2 implants, as estimated by blind histological scoring.
Etanercept does not appear to impair tendon or metaphyseal bone healing to any substantial degree.
With reasonable confidence, from our results we can exclude the possibility that etanercept has moderate to strong negative effects on metaphyseal bone and tendon healing. Previous tendon healing experiments with similar protocols and of comparable power showed that NSAID treatment had statistically significantly negative effects (Virchenko et al. 2004), suggesting that etanercept is less detrimental, although no direct comparison has been made.