Document Detail

Serum levels of osteoprotegerin and receptor activator of nuclear factor-kappaB ligand as markers of periprosthetic osteolysis.
MedLine Citation:
PMID:  16818976     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Previous studies have suggested that the balance between receptor activator of nuclear factor-kappaB ligand (RANKL) and its decoy-receptor osteoprotegerin (OPG) in local tissue seems to play a crucial role in the loosening of the total hip replacement. The aim of this study was to evaluate whether the circulating levels of OPG and RANKL, as well as their ratio, could be different in patients with aseptic loosening compared with patients with stable implants. METHODS: One hundred and twenty-eight subjects were recruited. They included thirty-nine patients with osteoarthritis who had not yet undergone total hip arthroplasty, thirty-three patients who had undergone total hip arthroplasty and had clinically and radiographically stable implants, thirty-six patients with aseptic loosening of total hip arthroplasty components, and twenty healthy volunteers. Serum levels of OPG and RANKL were measured with use of an immunoenzymatic method, and in each individual the OPG-to-RANKL ratio was calculated. RESULTS: In every group, a significant correlation was detected between OPG concentration and age (r = 0.58, p < 0.0001), especially in individuals older than fifty years, while gender and underlying disease were not found to influence serum levels of the tested parameters. In comparison with the levels in healthy donors and patients with a stable total hip replacement, the serum levels of OPG were increased in the patients who had not yet had an arthroplasty, those with aseptic loosening of a total hip replacement, and those with a cemented total hip replacement. Moreover, the OPG serum level provided good diagnostic accuracy in detecting the implant failure. A correlation was found between the sum of the osteolytic areas seen radiographically around the femoral stem and the RANKL level (r = 0.38, p = 0.02) and the OPG-to-RANKL ratio (r = -0.29, p = 0.04). CONCLUSIONS: An increase in OPG levels may reflect a protective mechanism of the skeleton to compensate for the osteolytic activity that occurs in severe osteoarthritis and in aseptic loosening. Prospective studies are needed to determine whether serum OPG levels could be used as markers for monitoring the stability of the implant, as well as for predicting aseptic loosening. LEVEL OF EVIDENCE: Diagnostic study, Level III. See Instructions to Authors for a complete description of levels of evidence.
Donatella Granchi; Andrea Pellacani; Mauro Spina; Elisabetta Cenni; Lucia Maria Savarino; Nicola Baldini; Armando Giunti
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  88     ISSN:  0021-9355     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-04     Completed Date:  2006-08-08     Revised Date:  2010-10-25    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1501-9     Citation Subset:  AIM; IM    
Laboratory for Pathophysiology of Orthopedic Implants, Istituti Ortopedici Rizzoli, via di Barbiano 1/10,40136 Bologna, Italy.
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MeSH Terms
Aged, 80 and over
Arthroplasty, Replacement, Hip*
Biological Markers / blood
Carrier Proteins / blood*
Case-Control Studies
Glycoproteins / blood*
Hip Prosthesis*
Membrane Glycoproteins / blood*
Middle Aged
Osteoarthritis, Hip / blood*,  surgery
Osteolysis / blood*
Prosthesis Failure
RANK Ligand
Receptor Activator of Nuclear Factor-kappa B
Receptors, Cytoplasmic and Nuclear / blood*
Receptors, Tumor Necrosis Factor / blood*
Reg. No./Substance:
0/Biological Markers; 0/Carrier Proteins; 0/Glycoproteins; 0/Membrane Glycoproteins; 0/Osteoprotegerin; 0/RANK Ligand; 0/Receptor Activator of Nuclear Factor-kappa B; 0/Receptors, Cytoplasmic and Nuclear; 0/Receptors, Tumor Necrosis Factor; 0/TNFRSF11A protein, human; 0/TNFRSF11B protein, human; 0/TNFSF11 protein, human

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