Association of interleukin‐1 receptor antagonist and interleukin‐6 polymorphisms with osteolysis after total hip arthroplasty: Comment on the article by Gordon et al

Gallo, Jiří; Petřek, Martin

doi:10.1002/art.24456

Cited by 2 publications

(1 citation statement)

References 39 publications

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“…The problematic issues have included small sample size, lack of agreement about the primary outcome and conditions interfering with it, or incorrect estimation of the effect size [35]. In this regard, here we present a study on an identical implant that was previously found to be prone to premature failure because of excessive polyethylene wear [20].…”

Section: Discussionmentioning

confidence: 97%

Functional variants of the P2RX7 gene, aseptic osteolysis, and revision of the total hip arthroplasty: A preliminary study

Mrázek¹,

Gallo²,

Stahelova³

et al. 2010

Human Immunology

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Section: Discussionmentioning

confidence: 97%

Functional variants of the P2RX7 gene, aseptic osteolysis, and revision of the total hip arthroplasty: A preliminary study

Mrázek¹,

Gallo²,

Stahelova³

et al. 2010

Human Immunology

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Reply to letter by Gallo and Petrek commenting on interleukin‐1 receptor antagonist and interleukin‐6 polymorphisms and post–total hip arthroplasty osteolysis

Gordon¹,

Kiss-Tóth²,

Stockley³

et al. 2009

Arthritis & Rheumatism

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of the journal, on the association of interleukin-1 receptor antagonist and interleukin-6 genes with osteolysis in patients who have previously undergone total hip arthroplasty (2). We are grateful to the journal for giving us the opportunity to respond to the questions raised, and we shall address these point by point.We agree with Drs. Gallo and Petrek's unpublished observation that assessment by plain radiography may underestimate the incidence of osteolysis. This is particularly a problem for detection around cementless acetabular prostheses, as indicated in the references they cited. However, all of the prostheses in our study were fully cemented, and with this process radiographic demarcation at the cement-bone interface is much more clearly apparent and generally correlates well with intraoperative findings of aseptic loosening (3). Further, all control patients in our series were asymptomatic, and any who exhibited possible radiographic evidence of loosening, according to well-established criteria (4,5), were excluded. We also had the historical radiographic record for most of these subjects and so were able to directly compare current radiographic appearance with the immediate postoperative appearance if there was any doubt regarding development of radiographic demarcation. Finally, in any event, the misclassification of osteolysis cases into the control group would have the statistical effect of underestimation of the genetic effect size, and would not generate a false-positive association.With regard to the term "osteolysis-free survival" and its use in the regression analysis, the incidence of osteolysis increases with time since surgery in all prosthesis series. For example, in a 25-year cohort study Berry et al found an osteolysis rate of 2.9% at 10 years, and 10.6% at 20 years (6). This experience has been replicated in the Norwegian, Swedish, Finnish, English, and Australian national joint registries. Osteolysis can also be regarded as a wear-dependent phenomenon that is a function of use, rather than time (7). Thus, we believe it was quite appropriate, and necessary, to include both total wear and duration of osteolysis-free survival since surgery as potentially relevant covariates in our logistic regression model. While it may not be possible to define the precise moment at which osteolysis starts, it is possible, and clinically relevant, to use the time at which the patient first presents to the physician and the diagnosis is made. To suggest that osteolysis-free survival time should be defined by regular and repeated imaging is impractical, economically unjustified, and risks unnecessarily exposing a large patient population to radiation.We agree that the pathogenesis of aseptic loosening is multifactorial, involving patient-, surgery-, and prosthesisrelated factors. In the Subjects and Methods section of the article (2) we clearly referenced the subject exclusion criteria for this study (8). In 80% of the study subjects the prosthesis was a Charnley; none of the implants used in the study ar...

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Association of interleukin‐1 receptor antagonist and interleukin‐6 polymorphisms with osteolysis after total hip arthroplasty: Comment on the article by Gordon et al

Cited by 2 publications

References 39 publications

Functional variants of the P2RX7 gene, aseptic osteolysis, and revision of the total hip arthroplasty: A preliminary study

Functional variants of the P2RX7 gene, aseptic osteolysis, and revision of the total hip arthroplasty: A preliminary study

Reply to letter by Gallo and Petrek commenting on interleukin‐1 receptor antagonist and interleukin‐6 polymorphisms and post–total hip arthroplasty osteolysis

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