Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee
Background:. Despite the general success of total knee arthroplasty (TKA), addressing periprosthetic joint infection (PJI) and the resulting long-term complications is a growing medical need given the aging population and the increasing demand for arthroplasty. A larger proportion of patients face r...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-03-01
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| Series: | JBJS Open Access |
| Online Access: | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00101 |
| _version_ | 1797894115740876800 |
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| author | Lara Biedermann Evgeniya Bandick Yi Ren, MD Serafeim Tsitsilonis, MD Stefanie Donner, MD Michael Müller, MD Georg Duda, PhD Carsten Perka, MD Arne Kienzle, MD |
| author_facet | Lara Biedermann Evgeniya Bandick Yi Ren, MD Serafeim Tsitsilonis, MD Stefanie Donner, MD Michael Müller, MD Georg Duda, PhD Carsten Perka, MD Arne Kienzle, MD |
| author_sort | Lara Biedermann |
| collection | DOAJ |
| description | Background:. Despite the general success of total knee arthroplasty (TKA), addressing periprosthetic joint infection (PJI) and the resulting long-term complications is a growing medical need given the aging population and the increasing demand for arthroplasty. A larger proportion of patients face revision surgery because of the long-term complication of aseptic loosening despite clearance of the infection. The pathomechanisms leading to prosthetic loosening are not understood as it has been widely assumed that the bone stock recovers after explantation revision surgery. While clinical observations suggest a reduced osteogenic potential in patients with PJI, knowledge regarding the relevant biology is sparse. In the present study, we investigated the inflammatory impact of PJI on the bone and bone marrow in the vicinity of the joint. Additionally, we evaluated changes in the local inflammatory environment in a 2-stage exchange at both explantation and reimplantation.
Methods:. In this study, we analyzed 75 human bone and bone-marrow specimens (obtained from 65 patients undergoing revision arthroplasty with cement for the treatment of PJI) for markers of inflammation. Samples were analyzed using hematoxylin and eosin overview staining, fluorescent immunohistochemical staining, flow cytometry, and polymerase chain reaction (PCR).
Results:. Leukocyte prevalence was significantly elevated at explantation (femur, +218.9%; tibia, +134.2%). While leukocyte prevalence decreased at reimplantation (femur, −49.5%; tibia, −34.2%), the number of cells remained significantly higher compared with the control group (femur, +61.2%; tibia, +54.2%). Expression of inflammatory markers interleukin (IL)-1α (femur, +2,748.7%; tibia, +1,605.9%), IL-6 (femur, +2,062.5%; tibia, +2,385.7%), IL-10 (femur, +913.7%; tibia, +897.5%), IL-12 (femur, +386.1%; tibia, +52.5%), IL-18 (femur, +805.3%; tibia, +547.7%), and tumor necrosis factor (TNF)-α (femur, +296.9%; tibia, +220.9%) was significantly elevated at prosthesis explantation in both femoral and tibial specimens. Expression remained significantly elevated at reimplantation for all inflammatory markers except IL-12 compared with the control group. Conversely, there were only limited inflammatory changes in the bone marrow environment.
Conclusions:. The present study demonstrated a strong and lasting upregulation of the proinflammatory environment in the joint-surrounding osseous scaffold in patients with PJI. Our data suggest that modulating the inflammatory environment has substantial potential to improve the clinical outcome in affected patients. |
| first_indexed | 2024-04-10T07:04:45Z |
| format | Article |
| id | doaj.art-405316e74dba4e02bbfc2732ab6b1a52 |
| institution | Directory Open Access Journal |
| issn | 2472-7245 |
| language | English |
| last_indexed | 2024-04-10T07:04:45Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | JBJS Open Access |
| spelling | doaj.art-405316e74dba4e02bbfc2732ab6b1a522023-02-27T09:03:21ZengWolters KluwerJBJS Open Access2472-72452023-03-018110.2106/JBJS.OA.22.00101JBJSOA2200101Inflammation of Bone in Patients with Periprosthetic Joint Infections of the KneeLara Biedermann0Evgeniya Bandick1Yi Ren, MD2Serafeim Tsitsilonis, MD3Stefanie Donner, MD4Michael Müller, MD5Georg Duda, PhD6Carsten Perka, MD7Arne Kienzle, MD81 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany2 Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Clinic for Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyBackground:. Despite the general success of total knee arthroplasty (TKA), addressing periprosthetic joint infection (PJI) and the resulting long-term complications is a growing medical need given the aging population and the increasing demand for arthroplasty. A larger proportion of patients face revision surgery because of the long-term complication of aseptic loosening despite clearance of the infection. The pathomechanisms leading to prosthetic loosening are not understood as it has been widely assumed that the bone stock recovers after explantation revision surgery. While clinical observations suggest a reduced osteogenic potential in patients with PJI, knowledge regarding the relevant biology is sparse. In the present study, we investigated the inflammatory impact of PJI on the bone and bone marrow in the vicinity of the joint. Additionally, we evaluated changes in the local inflammatory environment in a 2-stage exchange at both explantation and reimplantation. Methods:. In this study, we analyzed 75 human bone and bone-marrow specimens (obtained from 65 patients undergoing revision arthroplasty with cement for the treatment of PJI) for markers of inflammation. Samples were analyzed using hematoxylin and eosin overview staining, fluorescent immunohistochemical staining, flow cytometry, and polymerase chain reaction (PCR). Results:. Leukocyte prevalence was significantly elevated at explantation (femur, +218.9%; tibia, +134.2%). While leukocyte prevalence decreased at reimplantation (femur, −49.5%; tibia, −34.2%), the number of cells remained significantly higher compared with the control group (femur, +61.2%; tibia, +54.2%). Expression of inflammatory markers interleukin (IL)-1α (femur, +2,748.7%; tibia, +1,605.9%), IL-6 (femur, +2,062.5%; tibia, +2,385.7%), IL-10 (femur, +913.7%; tibia, +897.5%), IL-12 (femur, +386.1%; tibia, +52.5%), IL-18 (femur, +805.3%; tibia, +547.7%), and tumor necrosis factor (TNF)-α (femur, +296.9%; tibia, +220.9%) was significantly elevated at prosthesis explantation in both femoral and tibial specimens. Expression remained significantly elevated at reimplantation for all inflammatory markers except IL-12 compared with the control group. Conversely, there were only limited inflammatory changes in the bone marrow environment. Conclusions:. The present study demonstrated a strong and lasting upregulation of the proinflammatory environment in the joint-surrounding osseous scaffold in patients with PJI. Our data suggest that modulating the inflammatory environment has substantial potential to improve the clinical outcome in affected patients.http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00101 |
| spellingShingle | Lara Biedermann Evgeniya Bandick Yi Ren, MD Serafeim Tsitsilonis, MD Stefanie Donner, MD Michael Müller, MD Georg Duda, PhD Carsten Perka, MD Arne Kienzle, MD Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee JBJS Open Access |
| title | Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee |
| title_full | Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee |
| title_fullStr | Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee |
| title_full_unstemmed | Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee |
| title_short | Inflammation of Bone in Patients with Periprosthetic Joint Infections of the Knee |
| title_sort | inflammation of bone in patients with periprosthetic joint infections of the knee |
| url | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00101 |
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