A Prospective Assessment of Periprosthetic Bone Mineral Density and Osteoimmunological Biomarkers Variations After Total Knee Replacement Surgery

Abstract

Aseptic loosening is a major cause of premature failure of total knee replacement (TKR). Variations in periprosthetic bone mineral density (BMD) and osteoimmunological biomarkers levels could help to quantify prosthesis osteointegration and predict early aseptic loosening. The gene expression of 5 selected osteoimmunological biomarkers was evaluated in tibial plateau bone biopsies by real-time polymerase chain reaction and changes in their serum levels after TKR were prospectively evaluated with enzyme-linked immunosorbent assay for 1 yr after surgery. These variations were correlated to changes in periprosthetic BMD. Sixteen patients were evaluated. A statistically significant decrease in serum levels of Sclerostin (p = 0.0135) was observed immediately after surgery. A specular pattern was observed between dickkopf-related protein 1 and osteoprotegerin expression. No statistically significant changes were detectable in the other study biomarkers. Periprosthetic BMD did not change significantly across the duration of the follow-up. Prosthetic knee surgery has an impact on bone remodeling, in particular on sclerostin expression. Although not showing statistically significant changes, in the patterns of dickkopf-related protein 1, osteoprotegerin, and the ligand of the receptor activator of nuclear factor kappa-B symmetries and correspondences related to the biological activities of these proteins could be identified. Variation in osteoimmunological biomarkers after TKR surgery can help in quantifying prosthesis osteointegration.

Bone mineral density in osseointegration implant surgery: A review of current studies (Review)

“…A number of studies on THA and TKA found an increase in BMD at the tip of the implant but a notable decrease in the middle ROIs ( 40 , 41 ), and one found insignificant changes in BMD post-implantation ( 42 ). Interestingly, one study also found that a short stem implant resulted in significantly less BMD loss compared to a standard straight stem ( 43 ).…”

Osteomyelitis, Oxidative Stress and Related Biomarkers

“…Osteoblasts can also produce OPG, which acts as a decoy receptor, binding and blocking RANKL to inhibit osteoclasts activation and thus protect against bone loss [ 7 ]. Several studies have in fact proposed these new osteoimmunological biomarkers as useful tools in different conditions, for instance in assessing the progress of osteolytic bone metastases [ 7 ] or after total knee replacement surgery, to quantify the osteointegration of the prosthesis [ 8 ].…”