Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Abstract

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

Personalized digital simulation‑assisted acetabular component implantation in revision hip arthroplasty

“…Loosening of the prosthesis after hip arthroplasty often causes pain, resulting in limited walking and thus disuse osteoporosis (21)(22)(23). Revision hip arthroplasty has high risks and a number of variables, making it a difficult operation in joint surgery (24).…”

Synovialis folyadékból nyert extracellularis vesiculák proteomja és azok lehetséges funkciója befertőződött ízületi protézisekben

“…A jelenleg ismert biomarkerek nem alkalmazhatók egyedüli vizsgálatként a periprotetikus infekció diagnózisának felállításában, de kérdéses, hogy létezik-e olyan biomarker, amely egyedüli szereplőként biztos választ adhat erre a nehezen eldönthető kérdésre. Fröschen és mtsai közleményükben arra utalnak, hogy érdemes lehet gondolkodásmódot váltani és az "egy legjobb biomarker" kiválasztása helyett a gyulladásos folyamat megismerésére helyezni a fókuszt és abból meghatározni egy jellemző listát [35]. Ez a gondolkodás főként a krónikus, bizonytalan panaszokat okozó periprotetikus infekció esetében lehet fontos.…”

Periprosthetic joint infection and immunity: Current understanding of host–microbe interplay

“…102 The complement system, part of the innate immune response, is organized into a cascading hierarchy through three pathwaysclassical, alternative, and lectin, which leads to the generation of a MAC complex and lysing of target cells. 103 Complement factors involved in all three pathways including C1q, Cb3, C4b, C5, C5a, C9, B, D, H, I, and MBL are all upregulated in PJI-diagnosed synovial samples compared with aseptic cohorts 104 (Figure 1). Fisher et al 105 reported a technique using the CIBERSORTx transcriptomic-based cellular deconvolution tool that uses RNA extracted from synovial fluid to create a cellular profile with predictive power for PJI when changes in granulocyte, total macrophage/monocyte, M0 macrophages, and M2 macrophages are selectively increased.…”

“…The complement system, part of the innate immune response, is organized into a cascading hierarchy through three pathways—classical, alternative, and lectin, which leads to the generation of a MAC complex and lysing of target cells 103 . Complement factors involved in all three pathways including C1q, Cb3, C4b, C5, C5a, C9, B, D, H, I, and MBL are all upregulated in PJI‐diagnosed synovial samples compared with aseptic cohorts 104 (Figure 1).…”