Cytokine levels in synovial fluid from hips with well-functioning or loose prostheses

Background The most common complications of prosthetic hip joints are aseptic mechanical failure and infection. Delayed low-grade infections are seen most often, and they are also most difficult to distinguish from aseptic mechanical failures.Methods We conducted a prospective study to compare inflammatory markers in patients diagnosed with aseptic or septic prosthetic loosening. The diagnostic criteria were based on the decisions of experienced orthopedic surgeons and microbiological analysis of periprosthetic tissue samples taken perioperatively.Results Coagulase-negative staphylococci were the commonest pathogens in the infected patients. Pre-or perioperative elevation of C-reactive protein and erythrocyte sedimentation rate were significantly greater in the infection group, as were white blood cell count and levels of cytokines in synovial fluid. The patterns of infiltration of inflammatory cells in periprosthetic tissue were also significantly different between the groups.Interpretation A combination of clinical judgment and multiple tissue samples constitutes a good platform for distinguishing between septic and aseptic loosening of prostheses. Moreover, the combined use of several laboratory and histopathological markers of inflammation, especially infiltration of polymorphonuclear cells, further helps the diagnosis.

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“…The results regarding TNF-α and IL-6 correspond well with the observations of Nivbrant et al (1999).…”

Section: Discussionsupporting

confidence: 89%

Inflammatory response in 85 patients with loosened hip prostheses: A prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening

Nilsdotter-Augustinsson

Briheim

Herder

et al. 2007

Acta Orthopaedica

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“…13,22,23 However, the role of pro-inflammatory cytokines in human disease has been less well characterized. Although there are several reports clearly demonstrating elevated levels of tumor necrosis factor alpha (TNF-a) in serum, joint synovial fluid, and periprosthetic tissues of osteolysis patients, [24][25][26][27] others have failed to observe such differences, with TNF-a levels in osteolysis patients being similar or lower than controls, or undetectable. [28][29][30][31][32] These conflicting findings raise the possibility that the involvement of macrophages in osteolysis may not be limited to pro-inflammatory cytokine signaling.…”

Section: Introductionmentioning

confidence: 99%

Expression profiling reveals alternative macrophage activation and impaired osteogenesis in periprosthetic osteolysis

Koulouvaris

Ivashkiv

et al. 2007

Journal Orthopaedic Research

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Interactions between periprosthetic cells and prosthetic wear debris have been recognized as an important event in the development of osteolysis and aseptic loosening. Although the ability of wear debris to activate pro-inflammatory macrophage signaling has been documented, the full repertoire of macrophage responses to wear particles has not been established. Here, we examined the involvement of alternative macrophage activation and defective osteogenic signaling in osteolysis. Using real-time RT-PCR analysis of periprosthetic soft tissue from osteolysis patients, we detected elevated levels of expression of alternative macrophage activation markers (CHIT1, CCL18), chemokines (IL8, MIP1 a) and markers of osteoclast precursor cell differentiation and multinucleation (Cathepsin K, TRAP, DC-STAMP) relative to osteoarthritis controls. The presence of cathepsin K positive multinuclear cells was confirmed by immunohistochemistry. Reduced expression levels of the osteogenic signaling components BMP4 and FGF18 were detected. Expression levels of TNF-a, IL-6, and RANKL were unchanged, while the anti-osteoclastogenic cytokine OPG was reduced in osteolysis patients, resulting in elevated RANKL:OPG ratios. In vitro studies confirmed the role of particulate debris in alternative macrophage activation and inhibition of osteogenic signaling. Taken together, these results suggest involvement in osteolysis of alternative macrophage activation, accompanied by elevated levels of various chemokines. Increased recruitment and maturation of osteoclast precursors is also observed, as is reduced osteogenesis. These findings provide new insights into the molecular pathogenesis of osteolysis, and identify new potential candidate markers for disease progression and therapeutic targeting. ß

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“…Experimentally, micromotion alters the cellular response to wear debris by creating a more aggressive membrane around implants (Bechtold et al 1995). Therefore it seems essential to obtain a stable interface sealed off from joint fluid containing wear debris and osteoclast-activating factors (Nivbrant et al 1999). As regards non-cemented arthroplasty, experimental studies have shown promising effects of hydroxyapatite coating (Kraemer et al 1995, Søballe et al 1991, 1993a.…”

mentioning

confidence: 99%

Sealing effect of hydroxyapatite coating: A 12-month study in canines

Rahbek¹,

Overgaard²,

Jensen³

et al. 2000

Acta Orthopaedica Scandinavica

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Cytokine levels in synovial fluid from hips with well-functioning or loose prostheses

Cited by 32 publications

References 33 publications

Inflammatory response in 85 patients with loosened hip prostheses: A prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening

Inflammatory response in 85 patients with loosened hip prostheses: A prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening

Expression profiling reveals alternative macrophage activation and impaired osteogenesis in periprosthetic osteolysis

Sealing effect of hydroxyapatite coating: A 12-month study in canines

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