Enhanced migration of human bone marrow stromal cells in modified collagen hydrogels

Purpose

Collagen I hydrogels are widely used as scaffolds for regeneration of articular cartilage defects. We hypothesised that ingrowth might be improved by removing the superficial layer of a compressed hydrogel. The control group consisted of the original unmodified product.

Methods

The migration of human bone marrow stromal cells (hBMSCs) into the hydrogel was evaluated by confocal microscopy. We quantified the DNA concentration of the hydrogel for each group and time point and evaluated the chondrogenic differentiation of cells.

Results

After one week, the detectable amount of cells at the depth of 26–50 μm was significantly higher in the modified matrix (MM) than in the non-modified matrix (NM) (p = 0.011). The maximum depth of penetration was 75 μm (NM) and 200 μm (MM). After three weeks, the maximum depth of penetration was 175 μm (NM) and 200 μm (MM). Likewise, at a depth of 0–25 μm the amount of detectable cells was significantly higher in the MM group (p = 0.003). After 14 days, the concentration of DNA was significantly higher in the samples of the MM than in the control group (p = 0.000). Staining of histological sections and labelling with collagen II antibodies showed that a chondrogenic differentiation of cells in the scaffold can occur during in vitro cultivation.

Conclusions

Removing the superficial layer is essential to ensuring proper ingrowth of cells within the compressed hydrogel. Compressed hydrogels contribute better to cartilage regeneration after surface modification.     

Does total hip arthroplasty restore native hip anatomy? Three-dimensional reconstruction analysis

Purpose

Component orientations and positions in total hip arthroplasty (THA) are important parameters in restoring hip function. However, measurements using plain radiographs and 2D computed tomography (CT) slices are affected by patient position during imaging. This study used 3D CT to determine whether contemporary THA restores native hip geometry.

Methods

Fourteen patients with unilateral THA underwent CT scan for 3D hip reconstruction. Hip models of the nonoperated side were mirrored with the implanted side to quantify the differences in hip geometry between sides.

Results

The study demonstrated that combined hip anteversion (sum of acetabular and femoral anteversion) and vertical hip offset significantly increased by 25.3° ± 29.3° (range, −25.7° to 55.9°, p = 0.003) and 4.1 ± 4.7 mm (range, −7.1 to 9.8 mm, p = 0.009) in THAs.

Conclusions

These data suggest that hip anatomy is not fully restored following THA compared with the contralateral native hip.     

Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up

Purpose

Managing a deficient acetabulum in patients with developmental dysplasia of the hip (DDH) can be challenging. The purpose of the study was to determine the mid-term results of total hip arthroplasty (THA) using a bulk structural autograft for reconstruction of the acetabular roof in patients with DDH.

Methods

Between 1982 and 1999, 112 patients underwent THA with acetabular roof-plasty using a bulk structural autograft for secondary osteoarthritis related to DDH. A total of 106 patients (115 hips) met inclusion criteria and were followed for an average of 11.6 years (seven to 24 years). The mean age was 52.5 years at the index operation. Clinical and radiological evaluations were performed according to the methods of Merle d’Aubigné and Postel, Johnston et al. and DeLee and Charnley.

Results

The overall Merle d’Aubigné hip score significantly improved (3.7 vs 10.4, p < 0.01). The limb length discrepancy decreased from 30 to 6 mm (p < 0.01). The average distance that the hip centre was distalised was 22.3 mm (0–56 mm). However, radiolucent lines were observed in 27 % of patients at final follow-up, and the overall rate of revision for aseptic loosening was 16 %. Further, Kaplan-Meier survivorship curves predicted a rapid increase in the failure rate at 15 years.

Conclusions

The mid-term functional outcome of THA with an acetabular roof-plasty using a bulk autograft is satisfactory; however, the long-term results are questionable.     

A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess wether a dual mobility cup has a decreased dislocation risk

Purpose

Mid- and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85 % survivorship at 25-year follow-up. However, dislocation still remains an unsolved problem. Dislocation may occur throughout the patient’s and implant’s life. The aim of this study is to answer the question: does a dual mobility cup (DMC) decrease the dislocation risk?

Methods

We report comparative results at ten years of follow-up of two groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n = 215) and the other one with a DMC (group 2, n = 105).

Results

In group 1, 26 dislocations (12.9 %) occurred. In group 2 only one dislocation (0.9 %) occurred. This dislocation was successfully reduced by closed reduction, without any recurrence. This difference was statistically significant (p = 0.0018). In group 1, the reason for revision was recurrent dislocation in 21 cases. Five patients were revised for other reasons. The global revision rate was 12.9 %. In group 2, two patients needed revision surgery for aseptic loosening. The global revision rate was 2.1 %. This difference was statistically significant (p = 0.054). The goal was reached for the patients of group 2 who had more risks factors for dislocation (age, aetiology, American Society of Anesthesiologists and Devane scores) than those of group 1.

Conclusions

When using a DMC, we observed a low rate of dislocation in primary THA (0.9 %). This surgical choice seems to be a safe and effective technique in Charnley-type THA, especially in a high-risk population.     

Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures

Purpose

Total hip arthroplasty (THA) as primary treatment for displaced femoral neck fractures is controversial as THA is associated with higher rates of dislocation but lower rates of re-operation compared to hemiarthroplasty (HA). A dual mobility cup (DMC) design is associated with lower dislocation and re-operation rates in elective surgery. Is this also the case when used to treat displaced femoral neck fractures? The aim of this study is to compare rates of dislocation and re-operation of any kind following treatment for displaced femoral neck fractures with either bipolar HA or THA with DMC.

Methods

Two consecutive groups of patients treated for displaced femoral neck fractures at the Regional Hospital in Viborg in Denmark were included. In 2007–2008 171 patients (mean age 84.1 years) were treated with bipolar HA. In 2009–2010 175 patients (mean age 75.2 years) were treated with THA with DMC. Data regarding rates of dislocation and re-operation were obtained by retrospective review of medical records.

Results

We found a statistically significant difference regarding rates of dislocation and re-operation of any kind in favour of THA with DMC. Dislocation occurred in 25/171 patients [95 % confidence interval (CI) 9.3–19.9 %] treated with bipolar HA and 8/175 patients (95 % CI 1.5–7.7 %) treated with THA with DMC (p = 0.002). Re-operations were required in 32/171 patients (95 % CI 12.9–24.6 %) treated with bipolar HA and 16/175 patients (95 % CI 4.8–13.4 %) treated with THA with DMC (p = 0.01).

Conclusions

Our findings indicate that THA with DMC is superior to bipolar HA following treatment for displaced femoral neck fractures in regard to rates of dislocation and re-operation.     

Does stem design influence component positioning in total hip arthroplasty using a minimal invasive posterolateral approach?

Purpose

Limited data exist for the reconstructive potential of short bone-preserving stems in THA using a minimal invasive posterolateral approach. Our study aim was to assess the effect of stem design on the reconstruction of hip offset and leg length in MIS posterolateral THA.

Methods

This retrospective consecutive single-surgeon study compares hip offset and leg length, as well as acetabular component positioning (cup anteversion; inclination) of 129 THAs with a cementless standard-length stem (Synergy®) and 143 THAs with a cementless short bone-preserving stem (Trilock®).

Results

In reference to the contralateral side, the mean difference in hip offset was 0.9 mm (p = 0.067) for the standard stem and 0.1 mm (p = 0.793) for the short stem, respectively. Leg-length discrepancy was 0.7 mm (Synergy®) and 0.9 mm (Trilock®), respectively. A total of 233 (86 %) acetabular components fell within the target zone for anteversion and inclination.

Conclusion

Accurate component positioning in MIS posterolateral approach THA is possible and is not influenced by the type of stem.     

Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty: a randomised controlled trial

Purpose

A new intraoperative filtered salvaged blood re-transfusion system has been developed for primary total hip arthroplasty (THA) that filters and re-transfuses the blood that is lost during THA. This system is intended to increase postoperative haemoglobin (Hb) levels, reduce perioperative net blood loss and reduce the need for allogeneic transfusions. It supposedly does not have the disadvantages of intraoperative cell-washing/separating re-transfusion systems, such as extensive procedure, high costs and need for specialised personnel. To re-transfuse as much as blood as possible, postoperatively drained blood was also re-transfused.

Methods

A randomised, controlled, blinded, single-centre trial was conducted in which 118 THA patients were randomised to an intraoperative autologous blood re-transfusion (ABT) filter system combined with a postoperative ABT filter unit or high-vacuum closed-suction drainage.

Results

On average, 577 ml of blood was re-transfused in the ABT group: 323 ml collected intraoperatively and 254 ml collected postoperatively. Hb level was higher in the ABT vs the high-vacuum drainage group: 11.4 vs. 10.8 g/dl, p = 0.02 on day one (primary endpoint) and 11.0 vs. 10.4 g/dl, p = 0.007 on day three. Total blood loss was less in the autotransfusion group: 1472 vs. 1678 ml, p = 0.03. Allogeneic transfusions were needed in 3.6 % of patients in the ABT group and 6.5 % in the drainage group, p = 0.68.

Conclusion

The use of a new intraoperative ABT filter system combined with a postoperative ABT unit resulted in higher postoperative Hb levels and less total blood loss compared with a high-vacuum drain following THA.     

Prosthetic radial head stem pull-out as a mode of failure: a biomechanical study

Purpose

Press-fit cementless radial head implant longevity relies on adequate bone ingrowth. Failed implant osseointegration remains a clinical concern and has been shown to lead to prosthetic failure. The purpose of this study was to test the hypothesis that implants with sufficient initial press-fit stability would be less likely to fail due to implant pull-out, as demonstrated by an increasing amount of energy required to remove the prosthesis from the canal.

Methods

Ten cadaveric radii were implanted with five sizes (6–10 mm in 1-mm increments) of grit-blasted, cementless radial head stems. A customised slap hammer was used to measure the energy required to remove each stem. Stem-bone micromotion was also measured.

Results

The suboptimally sized stem (Max − 1) (i.e. 1 mm undersized) required less energy (0.5 ± 0 J) to pull out than the optimally sized stem (Max) (1.7 ± 0.3 J) (p = 0.008). The optimally sized stem demonstrated greater initial stability (45 ± 7 μm) than the suboptimally sized stem (79 ± 12 μm) (p = 0.004).

Conclusions

This investigation demonstrates the importance of obtaining adequate press-fit stability for the prevention of radial head stem pull-out failure. These data add to the relatively scant knowledge in the literature regarding radial head biomechanics. The energy required to remove a prosthetic radial head ingrowth stem decreases in conjunction with diameter. The use of an inadequately sized stem increases the stem’s micromotion as well as the risk of prosthetic loosening due to pull-out.     

Hip score and disease activity correlation in patients with rheumatoid arthritis after total hip arthroplasty

Purpose

The disease activity score including 28 joints (DAS28), the simplified disease activity index and the clinical disease activity index (CDAI) were developed in order to provide a quantifiable measure of rheumatoid arthritis (RA) activity. Although inflamed hip joints greatly impact activities of daily living (ADL) and walking ability, the hip joint was not included in the DAS28, SDAI or CDAI assessments. Although excellent clinical results have been reported for total hip arthroplasty (THA) in RA patients, correlations between disease activity and hip function in RA patients after THA remain unknown.

Methods

We analysed the effect of RA disease activity on a hip function score in an observational cohort of RA patients after THA. Twenty-five registered RA patients who had undergone THA (33 joints) were included. Hip function was recorded and RA disease activity was measured on the same day. The mean age of the patients was 65.17 years. They were followed up for a mean of 5.24 years after surgery. The mean duration of disease following RA diagnosis for this patient group was 19.47 years. The Japanese Orthopaedic Association (JOA) hip score was used as a clinical outcome measure for hip dysfunction. RA disease activity and health-related quality of life were measured using the DAS28, SDAI, CDAI and the modified health assessment questionnaire (MHAQ).

Results

The mean JOA score for hip function was 80.48 at the final follow-up. The mean DAS28-ESR, DAS28-CRP, SDAI, CDAI and MHAQ measuring RA disease activity levels were 3.38, 2.65, 9.59, 8.63 and 0.44, respectively, at the final follow-up. There was a significant negative correlation between the JOA hip score and all disease activity assessments observed after THA (DAS-ESR [P = 0.0067], DAS-CRP [P = 0.0008]), SDAI [P = 0.0034], CDAI [P = 0.0003]) and MHAQ [P = 0.0002]).

Conclusion

We found significant negative correlations between JOA hip scores and all disease activity assessments in RA patients treated with THA.     

Influencing factors for the increased stem version compared to the native femur in cementless total hip arthroplasty

Purpose

Stem version is not always equivalent to femoral neck version (native version) in cementless total hip arthroplasty (THA). We therefore examined the discrepancy of version between the native femoral neck and stem using pre- and postoperative computed tomography (CT), the level of the femur where the canal version most closely fit the stem version, and the factors influencing version discrepancy between the native femoral neck and stem.

Methods

A total of 122 hips in 122 patients who underwent primary THA using a metaphyseal-fit stem through the postero-lateral approach were included. Pre- and postoperative CT images were utilized to measure native and stem version, and the version of the femoral canal at four levels relative to the lesser trochanter.

Results

The mean native and stem versions were 28.1 ± 11.0° and 38.0 ± 11.2°, respectively, revealing increased stem version with a mean difference of 9.8° (p < 0.0001). A total of 84 hips (68.9 %) revealed an increase in version greater than 5°. Femoral canal version at the level of the lesser trochanter most closely approximated that of stem version. Among the factors analysed, both univariate and multivariate analysis showed that greater degrees of native version and anterior stem tilt significantly reduced the version discrepancy between the native femoral neck and stem version.

Conclusions

Since a cementless stem has little version adjustability in the femoral canal, these findings are useful for surgeons in preoperative planning and to achieve proper component placement in THA.     

Subsidence of a cementless femoral component influenced by body weight and body mass index

Purpose

This trial was designed to evaluate the impact of physical characteristics such as body mass index, body weight and height on distal stem migration of a cementless femoral component, as the influence of obesity on the outcome of THA is still debated in literature and conflicting results have been found.

Methods

In this retrospective cohort study, migration patterns for 102 implants were analysed using the Einzel-Bild-Roentgen-Analyse (EBRA-FCA, femoral component analysis). In all cases the Vision 2000 stem was implanted and combined with the Duraloc acetabular component (DePuy, Warsaw, Indiana).

Results

The mean follow-up was 93 months. EBRA-FCA evaluations revealed a mean subsidence of 1.38 mm after two years, 2.06 mm after five and 2.24 mm after seven years. Five stems loosened aseptically. Correlation between increased migration over the whole period and aseptic loosening was highly significant (p < 0.001). Surgical technique had a significant influence on migration and stem stability (p = 0.002) but physical patient characteristics such as body weight over 75 kg and height over 165 cm also significantly influenced stem subsidence towards progressive migration (p = 0.001, p < 0.001). However, a high BMI did not trigger progressive stem migration (p = 0.87). Being of the male gender raised the odds for increased migration (p = 0.03).

Conclusion

Physical characteristics such as body weight and height showed significant influence on migration patterns of this cementless femoral component. The operating surgeon should be aware that body weight above 75 kg and height over 165 cm may trigger increased stem migration and the surgeon should aim to fit these prostheses as tightly as possible. However this study demonstrates that a high BMI does not trigger progressive stem migration. Further investigations are needed to confirm our findings.     

Evaluation of the accuracy of femoral component orientation by the CT-based fluoro-matched navigation system

Purpose

Accurate orientation of acetabular and femoral components are important during THA. However, no study has assessed the use of the CT-based fluoro-matched navigation system during THA. Therefore, we have evaluated the accuracy of stem orientation by CT-based fluoro-matched navigation.

Methods

The accuracy of stem orientation by CT-based fluoro-matched navigation was assessed by postoperative CT data. Furthermore, we compared the postoperative stem orientation with the intraoperative registration errors.

Results

The average antetorsion error of the stem (navigation records − postoperative CT) was −0.5° ± 5.2°. The stem valgus error was 0.4° ± 2.7°. The accuracy of the navigation record for the orientation of the stem valgus was dependent on the intraoperative registration errors.

Conclusions

The clinical accuracy of CT-based fluoro-matched navigation is adequate for stem alignment orientation, and the intraoperative verification of registration errors is valuable for checking the accuracy of stem orientation by navigation.     

Magnetic Resonance Imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair

Purpose

The purpose of this study was to assess the MRI features of the all-inside repaired meniscus in the long-term.

Methods

Among 27 consecutive all-inside arthroscopic meniscal repairs, 23 patients aged 25 ± 5 years at the time of surgery were reviewed at a median follow-up of 10 ± 1 years. Retrospective clinical examinations and imaging assessments using a 1.5-T MRI after all-inside arthroscopic meniscal repair were conducted.

Results

At follow-up, Lysholm and IKDC averaged 89 ± 11 and 95 ± 8, respectively. MRI examinations revealed no meniscal signal alteration in three patients (13 %), a vertical signal located in the previously torn area in seven (30 %), a horizontal grade 3 in nine (39 %), and a complex tear (grade 4) in four (17.5 %). There were no differences between medial and lateral menisci (p = 0.15), stable and stabilised knees (p = 0.56).

Conclusions

Several abnormal vertical and/or horizontal hypersignals are still present on MRI examination ten years after arthroscopic all-inside meniscal repair. The appearance of early signs of osteoarthritis is rare, suggesting a chondroprotective effect of the repaired meniscus.     

Recurrence of Dislocation Following Total Hip Arthroplasty Revision Using Dual Mobility Cups Was Rare in 180 Hips Followed Over 7?Years

Background

Dual mobility (DM) cups of mobile polyethylene were introduced to prevent total hip arthroplasty (THA) dislocation, but no large series with this design to treat recurrent instability have been reported.

Purpose

Our retrospective investigation ascertained the efficiency of DM cups in correction of recurrent dislocation and assessed any adverse effects.

Methods

One hundred eighty THAs with recurrent instability were revised to DM cups in 180 patients (mean age, 67.4 ± 11.7 years; range, 19 to 92 years). Thirty-one patients (17.2%) underwent at least one earlier THA revision, and 15 (10.3%) incurred non-union of the greater trochanter. Of the initial group in 2009, 145 patients had completed evaluations which included assessment of the Harris Hip Score and a radiographic assessment at a mean follow-up of 7.7 ± 2.2 years (range, 4 to 14 years). The rate of survival was calculated considering any reason for revision as failure.

Results

At follow-up, Harris hip score was 83.9 ± 16.1 (range, 21 to 100). Dislocation of the large articulation occurred in seven hips (4.8%), and only two recurred (1.4%) (one requiring additional revision). In addition, two intra-prosthetic dislocations of the small articulation (1.4%) were observed and needed revision surgery. The large number of earlier surgeries and non-union of the greater trochanter were related to recurrent instability. Two cups (1.4%) showed signs of definite loosening; six (4.1%) presented signs of possible loosening. Twenty-nine hips manifested femoral or acetabular osteolysis (20%), but only three were severe. Eight-year survival rate considering revision for any reason was 92.6% (95% CI, 85.5–96.4%).

Conclusions

This series indicates that DM cups are a viable option to treat recurrent THA instability. Their design provides a low risk of recurrent instability without increasing mechanical complications.     

Integrated care pathways in lower-limb arthroplasty: are they effective in reducing length of hospital stay?

Purpose

The aim of this study was to examine the effect of an integrated care pathway (ICP) for total hip and knee arthroplasty (THA/TKA) on length of stay (LOS), day of surgery admission rate (DOSA) and postoperative length of stay (POLOS).

Methods

Three hundred and eight THAs and 299 TKAs were assessed in a retrospective before–after trial design. LOS, POLOS and DOSA were recorded for patients before and after introduction of the ICP. The ICP encompassed a patient education programme, specific daily management goals, variance mapping, daily facilitated meetings and a DOSA policy. Subgroup analysis according to age and gender was also performed.

Results

Mean LOS was significantly reduced by 1.4 (from 6.9 to 5.5) days for THA and 0.8 (from 6.4 to 5.6) days for TKA. Elderly patients and men achieved greater LOS reductions than their counterparts for both operations. Younger patients undergoing THA achieved a significantly higher DOSA rate than older patients (89 % vs 71 %, p = 0.010); however, this difference was not observed in the TKA population. Mean POLOS for THA was reduced by 0.6 (from 5.9 to 5.3) days, again with the greatest benefit seen in elderly and male patients. POLOS for TKA patients was not significantly affected by the ICP.

Conclusions

The introduction of an ICP reduced LOS by 1.4 days for THA and 0.8 days for TKA. Elderly and male patients benefitted most.     

Association analysis of two candidate polymorphisms in the Tumour Necrosis Factor-α gene with osteoarthritis in a Chinese population

Purpose

The purpose of this study was to investigate the possible association between single nucleotide polymorphisms (SNPs) rs1800629 (TNF-α -308) and rs361525 (TNF-α -238) of the tumour necrosis factor (TNF)-α gene and susceptibility to osteoarthritis (OA) in the Han Chinese population.

Methods

The TNF-α -308 and -238 genotypes were determined by TaqMan assay in 200 OA cases and 305 controls. Odds ratios (ORs) for OA and 95 % confidence intervals (CIs) from unconditional logistic regression models were used to evaluate relative risks.

Results

The frequencies of the allele ‘A’ of rs1800629 were 16 % and 8.85 % in OA cases and in controls, respectively, and thus the -308A allele had a 1.9612-fold (95 % CI = 1.3323–2.8869, P < 0.001) increased risk for OA as compared to the -308G allele. However, no significant differences were found in the genotype and allele frequencies for rs361525 between OA and HC groups.

Conclusions

In the Han Chinese population, the allele ‘A’ of TNF-α -308 may increase the risk for OA, whereas TNF-α -238 polymorphisms do not play a role in OA patients.     

Factors predictive of positive response to steroid therapy in simple bone cysts: an old trick that still works

Purpose

The aim of the study was to identify clinical, demographic and radiological factors predicting a positive response to steroid treatment in simple bone cysts (SBCs).

Methods

A retrospective study was conducted on 62 patients. The mean follow-up period was 9.2 years after the final steroid injection. Recurrences were defined according to Neer’s scale as modified by Chang et al.. To identify predictive factors, the group of patients who positively responded to treatment (Neer stages I and II, n = 39, 62.9 %, group 1) were compared with the group in which recurrences occurred (Nerr stages III and IV, n = 23, 37.1 %, group 2).

Results

Recurrences were experienced by 37.1 % of the patients (n = 23). Cyst location, numbers of cavities (uni- or multilocular), the area of the cyst and its Enneking stage differed significantly between the groups (p < 0.05).

Conclusions

Steroid therapy may be of benefit in patients with unilocular, small-sized, humeral cysts, classified as Enneking stage IA.     

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Purpose

The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions.

Methods

Between January 2011 and December 2011, patients being treated with revision THA were included (n = 411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m²), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre- and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded.

Results

In both the cemented and non-cemented revision THA groups, there was no significant difference between pre- and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5 %) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5 %), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p = 0.0042, odds ratio = 2.035).

Conclusions

Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT.     

Multiple biomarkers analysis for the early detection of prosthetic aseptic loosening of hip arthroplasty

Purpose

Our aim was to define the effect of multiple biomarkers of osteolysis or bone remodelling in the early detection of aseptic loosening (AL) of total hip arthroplasty (THA).

Method

One hundred subjects were recruited, including 31 candidates for revision THA (Late AL group), 15 patients who had undergone THA and had clinical and radiographic evidence of AL (early AL group), 19 patients with no sign of AL (stable group), and 40 healthy volunteers. Plasma levels of osteoprotegerin (OPG), receptor activator of nuclear factor-kappaB ligand (RANKL), cross-linked N-terminal telopeptide (NTX), procollagen I C-terminal extension peptide (PICP), tumour necrosis factor-alpha (TNF-α), and interleukin (IL)-1β1 were measured using an immunoenzymatic method. The outcomes of biomarkers were analysed separately and synthetically using Revman software.

Results

The plasma level of OPG, RANKL, NTX, TNF-α, and IL-1β declined from late AL, early AL, stable to the healthy group, while the level of PICP inclined reversely. There was a significant difference in synthetic analysis of six biomarkers between the AL group and the stable group, and between the stable group and the healthy group (both p = 0.02). Heterogeneity of six biomarkers in either comparison was extremely low (both I² =0). Patients who had cemented implants had significantly higher levels of TNF-α than patients with cementless varieties (p = 0.042).

Conclusion

There was significant change in the plasma level of multiple biomarkers in patients with prosthetic AL of THA, especially in the cemented arthroplasties and in patients without traditional clinical or radiographic evidence of AL.