| Study | Study Design/Level of Evidence | Comparisons | Outcomes | Other Notes |
|---|---|---|---|---|
| Antonioiu 2000 | case control study/Level III | Hip osteolysis (n = 11), hip arthroplasty without osteolysis (n = 8), healthy controls (n = 7), hip osteolysis following alendronate therapy x6 weeks (n = 10) | Urinary cross-linked Ntelopeptide of type I collagen; | Longer average time from original operation in osteolysis group (8.8yrs) vs. fixed implants (2.4yrs) |
| Von Schewelov 2006 | case control study/Level III | Hip osteolysis (n = 33); hip arthroplasty without osteolysis (n = 127) | urinary cross-linked Ntelopeptide of type I collagen | Post-operative time in osteolysis was 73 months vs. 42 months in nonosteolysis group. |
| Arabmotlagh 2006 | Prospective cohort study/Level II | 53 patients with unilateral THA for OA; followed with bone density scans on 2, 4, 6, and 12mos post-op and correlated to marker measured at 3, 6, 16, and 24 weeks post-op. | Serum C-terminal telopeptide of type I collagen; bone ALP, osteocalcin | Numerous comparisons from BMD and biomarkers lessen reliability of findings. |
| Hernigou 1999 | case control study/Level III | Hip osteolysis, >10yrs postop (n = 6); hip arthroplasty without osteolysis, >10yrs post-op (n = 10); hip arthroplasty without osteolysis, <6yrs post-op (n = 6); healthy controls (n = 5) | IL-B, TNF-a, IL-6, CRP | |
| Fiorito 2003 | case control study/Level III | Hip osteolysis (n = 8); hip arthroplasty without osteolylsis (n = 10); healthy controls (n = 17) | IL-1B, IL-6, TNF-a, TGF-B, PGE-2, MMP-1, IL-11 | |
| Schneider 1998 | case control study/Level III | Aseptic loosening of hip implant (n = 50); fixed hip implant (n = 50) | Bone ALP, osteocalcin, serum C-terminal propeptide of type I procollagen, urine crosslinked N-telopeptide of type I collagen, urine pyridinoline, urine deoxypyridinonline | |
| Savarino 2005 | case control study/Level III | Aseptic loosening of hip implant (n = 21), fixed hip implant (n = 18), OA patients at time of primary arthroplasty (n = 17), healthy controls (n = 30) | Serum cross-linked Ntelopeptide of type I collagen, serum C-terminal propeptide of type I procollagen | Healthy controls not matched for age or gender and not used in statistical comparisons |
| Li 2004 | prospective cohort study/Level II | 45 patients followed prospectively after TKA; biomarker measured at 1 week and 3, 6, 12, and 24 months post-op; compared to quality of fixation measured by RSA1 – MTPM2 >0.2mm represented unstable fixation, <0.2mm represented stable fixation | serum C-terminal propeptide of type I procollagen; serum cross-linked C-terminal telopeptide of type I collagen; osteocalcin | A part of an 80 patient randomized prospective study comparing cemented to uncemented fixation of tibial component for TKA, 45 agreed for blood tests; excluded patients without RSA data at 1 or 2 years (5 patients) |
| Wilkinson 2003 | case control study/Level III | Aseptic loosening of hip implant (n = 26); stable fixation of hip implant (n = 23) | Bone ALP, serum cross-linked C-terminal telopeptide, osteocalcin, serum N-terminal propeptide of type I procollagen, urine cross-linked N-telopeptide of type I collagen, free deoxypyridinoline | Only provided data for either femoral or pelvic loosening when compared to fixed implants |
| Moreschini 1997 | case control study/Level III | Aseptic loosened hip prosthesis (n = 9); fixed hip prosthesis (n = 13); OA patients prior to primary arthroplasty (n = 13) | Hyaluronic acid, IL-1B, type III procollagen peptide | |
| Granchi 1998 | case control study/Level III | Aseptic loosening of hip prosthesis (n = 35), healthy controls (n = 25) | IL-1a, IL-1B, IL-6, GM-CSF, IL-2 receptor, TNF-a | Differentiated failed arthoplasties to those with CrCoMo or TiAIV components |
| Hundri-Haspl 2006 | case control study/Level III | Large joint implant loosening (n = 50), large joint arthroplasty without loosening (n = 50), candidates for arthroplasty from advanced OA (n = 50), healthy controls (n = 50) | IL-1B, IL-8, TNF-a | Specific type of large joint prostheses not reported |
| Streich 2003 | case control study/Level III | Aseptic loosening of hip prosthesis (n = 23), fixed hip prosthetic implant (n = 23) | IL-6, GM-CSF, elastase | Significantly more males in healthy donors |
| Granchi 2006 | case control study/Level III | Aseptic loosening of hip implant (n = 36), fixed hip implant (n = 33), severe OA prior to arthroplasty (n = 39), healthy subjects (n = 20) | Osteoprotegerin, RANKL | Significantly more males in healthy donors; significantly longer duration for post-op evaluation in loosening (112 mos) vs. stable joint (32 mos) |
| Synpniewska 2002 | case control study/Level III | aseptic loosening of hip implant (n = 10); primary OA patients undergoing primary arthroplasty (n = 39) | synovial levels: osteocalcin, B-crosslaps, IL-1a, IL-8, IL-10 | no fixed arthroplasty control group; excluded patients from analysis if missing outcome data |
| Kovacik 2000 | case control study/Level III | hip implant revisions (n = 20); primary OA patients undergoing primary arthroplasty (n = 7) | synvoial levels: TRAP, IL-1B | does not specific reasions for hip implant revions |
| Nivbrant 1999 | case control study/Level III | loose hip prosthesis (n = 38), fixed hip arthroplasty (n = 12); OA patients undergoing primary arthroplasty (n = 38) | synovial levels: IL-1B, TNF-a, IL-6 | mean time from implantation for loose prosthetics was 9.8yrs vs. 2.8yrs in fixed implant; excluded patients from analysis if missing data; median data only |
| Kawasaki 2001 | case control study/Level III | loosened hip prosthesis (n = 5), OA patients from primary hip dysplasia (n = 19), osteonecrosis of femoral neck (n = 21) | synovial levels: YKL-40 | average age for OA patients was 48 vs. 63 in loosed implant group; median data only |
| Nildotter 2007 | case control study/Level III | infected hip implants (n = 25), loosened hip implant (n = 60), OA patients undergoing primary arthroplasty (n = 46) | synovial levels: lactate, TNFa, IL-1B, IL-6 serum levels: CRP, ESR, IL-6, TNF-a, IL- 1B | no data provided on serum cytokine levels collected; no comparisons to OA control group provided; excluded patients from analysis if missing data |
| Bottner 2007 | case control study/Level III | septic revision for large joints (n = 21); aseptic revision of large joints (n = 57) | CRP, ESR, IL-6, TNF-a, procalcitonin | Knee/hip revisions: 5/16 for septic, 23/34 for aseptic |
| Frank 2004 | case control study/Level III | staph cultures from prosthetic joint infections compared to coag (-) staph cultures from non-prosthetic joint infections | icaADBC operon | |
| Galdbert 2000 | case control study/Level III | staph epidermidis strains from prosthetic infections (n = 54), staph epidermidis strains from skin flora from 8 healthy individuals | ica operon, biofilm production, genes: clfA, atlE, fbe, fnbA, cna | |
| Di Cesare 2005 | case control study/Level III | 58 patients undergoing reoperation of hip or knee: 17 patients with septic prosthetic infection; 41 patients without evidence of infection | CRP, ESR, IL-6 | |
| Rafiq 2000 | case control study/Level III | patients with prosthetic infection from gram positive organisms (n = 15), control group of 32 patients – 21 with closed fracture, 11 with primary OA | IgG and IgG to lipoteichoic acid | |
| Spangehl 1999 | prospective cohort study/Level II | prospectively evaluated 178 patients undergoing revision hip replacements | determined specificity, sensitivity for CRP, ESR in prosthetic infections | no specific data provided for comparison analysis; excluded patients from analysis if missing data |
| Hall 2001 | prospective study/Level II | 102 patients undergoing primary THA | serum levels: norepinephrine, epinephrine, cortisol, IL-6, CRP; pain, function, and WOMAC3 at 1 and 6 months; | |
| Wozniak 2004 | prospective cohort study/Level II | 33 patients undergoing primary TKA or THA due to OA, divided amongst those experiencing pain (n = 8) and no pain (n = 25) after 2-3 years; 14 healthy controls | neutrophils isolated from peripheral blood and analyzed for NO production – at basline, 2 weeks, 2 months, and 2-3 years post-operatively; | no apparent tool for pain assessment provided; 5/8 reporting pain had evidence of loosening |
| Messiah 1996 | prospective cohort study/Level II | 11 patients undergoing revision TKA; ruled out infection; | synovial LDH levels and correlated to presence of polyethyelene wear | no control group; no apparent standardized method for measurement of polyethyelene wear reported |
| Wilkinson 2003 | case control study/Level III | 20 patients undergoing primary THA or OA; compared development of heterotopic ossification by 26 weeks (n = 9) with those without evidence of such (n = 11) | N-terminal propeptide of type- I procollagen, osteocalcin, bone ALP, C-telopeptide of type-I collagen, urine crosslinked N-telopeptide of type-I collagen and free deoxypridinoline | no control group; only 26 weeks followup for development of heterotopic ossification |
| Ackland 2007 | prospective cohort study/Level II | 129 patients undergoing THA or TKA, divided amongst those with hsCRP >3mg/L (n = 63) and those with hsCRP <3mg/L (n = 66) | length of stay, morbid events |
| Study | Study Design/Level of Evidence | Comparisons | Outcomes | Other Notes |
|---|---|---|---|---|
| Antonioiu 2000 | case control study/Level III | Hip osteolysis (n = 11), hip arthroplasty without osteolysis (n = 8), healthy controls (n = 7), hip osteolysis following alendronate therapy x6 weeks (n = 10) | Urinary cross-linked Ntelopeptide of type I collagen; | Longer average time from original operation in osteolysis group (8.8yrs) vs. fixed implants (2.4yrs) |
| Von Schewelov 2006 | case control study/Level III | Hip osteolysis (n = 33); hip arthroplasty without osteolysis (n = 127) | urinary cross-linked Ntelopeptide of type I collagen | Post-operative time in osteolysis was 73 months vs. 42 months in nonosteolysis group. |
| Arabmotlagh 2006 | Prospective cohort study/Level II | 53 patients with unilateral THA for OA; followed with bone density scans on 2, 4, 6, and 12mos post-op and correlated to marker measured at 3, 6, 16, and 24 weeks post-op. | Serum C-terminal telopeptide of type I collagen; bone ALP, osteocalcin | Numerous comparisons from BMD and biomarkers lessen reliability of findings. |
| Hernigou 1999 | case control study/Level III | Hip osteolysis, >10yrs postop (n = 6); hip arthroplasty without osteolysis, >10yrs post-op (n = 10); hip arthroplasty without osteolysis, <6yrs post-op (n = 6); healthy controls (n = 5) | IL-B, TNF-a, IL-6, CRP | |
| Fiorito 2003 | case control study/Level III | Hip osteolysis (n = 8); hip arthroplasty without osteolylsis (n = 10); healthy controls (n = 17) | IL-1B, IL-6, TNF-a, TGF-B, PGE-2, MMP-1, IL-11 | |
| Schneider 1998 | case control study/Level III | Aseptic loosening of hip implant (n = 50); fixed hip implant (n = 50) | Bone ALP, osteocalcin, serum C-terminal propeptide of type I procollagen, urine crosslinked N-telopeptide of type I collagen, urine pyridinoline, urine deoxypyridinonline | |
| Savarino 2005 | case control study/Level III | Aseptic loosening of hip implant (n = 21), fixed hip implant (n = 18), OA patients at time of primary arthroplasty (n = 17), healthy controls (n = 30) | Serum cross-linked Ntelopeptide of type I collagen, serum C-terminal propeptide of type I procollagen | Healthy controls not matched for age or gender and not used in statistical comparisons |
| Li 2004 | prospective cohort study/Level II | 45 patients followed prospectively after TKA; biomarker measured at 1 week and 3, 6, 12, and 24 months post-op; compared to quality of fixation measured by RSA1 – MTPM2 >0.2mm represented unstable fixation, <0.2mm represented stable fixation | serum C-terminal propeptide of type I procollagen; serum cross-linked C-terminal telopeptide of type I collagen; osteocalcin | A part of an 80 patient randomized prospective study comparing cemented to uncemented fixation of tibial component for TKA, 45 agreed for blood tests; excluded patients without RSA data at 1 or 2 years (5 patients) |
| Wilkinson 2003 | case control study/Level III | Aseptic loosening of hip implant (n = 26); stable fixation of hip implant (n = 23) | Bone ALP, serum cross-linked C-terminal telopeptide, osteocalcin, serum N-terminal propeptide of type I procollagen, urine cross-linked N-telopeptide of type I collagen, free deoxypyridinoline | Only provided data for either femoral or pelvic loosening when compared to fixed implants |
| Moreschini 1997 | case control study/Level III | Aseptic loosened hip prosthesis (n = 9); fixed hip prosthesis (n = 13); OA patients prior to primary arthroplasty (n = 13) | Hyaluronic acid, IL-1B, type III procollagen peptide | |
| Granchi 1998 | case control study/Level III | Aseptic loosening of hip prosthesis (n = 35), healthy controls (n = 25) | IL-1a, IL-1B, IL-6, GM-CSF, IL-2 receptor, TNF-a | Differentiated failed arthoplasties to those with CrCoMo or TiAIV components |
| Hundri-Haspl 2006 | case control study/Level III | Large joint implant loosening (n = 50), large joint arthroplasty without loosening (n = 50), candidates for arthroplasty from advanced OA (n = 50), healthy controls (n = 50) | IL-1B, IL-8, TNF-a | Specific type of large joint prostheses not reported |
| Streich 2003 | case control study/Level III | Aseptic loosening of hip prosthesis (n = 23), fixed hip prosthetic implant (n = 23) | IL-6, GM-CSF, elastase | Significantly more males in healthy donors |
| Granchi 2006 | case control study/Level III | Aseptic loosening of hip implant (n = 36), fixed hip implant (n = 33), severe OA prior to arthroplasty (n = 39), healthy subjects (n = 20) | Osteoprotegerin, RANKL | Significantly more males in healthy donors; significantly longer duration for post-op evaluation in loosening (112 mos) vs. stable joint (32 mos) |
| Synpniewska 2002 | case control study/Level III | aseptic loosening of hip implant (n = 10); primary OA patients undergoing primary arthroplasty (n = 39) | synovial levels: osteocalcin, B-crosslaps, IL-1a, IL-8, IL-10 | no fixed arthroplasty control group; excluded patients from analysis if missing outcome data |
| Kovacik 2000 | case control study/Level III | hip implant revisions (n = 20); primary OA patients undergoing primary arthroplasty (n = 7) | synvoial levels: TRAP, IL-1B | does not specific reasions for hip implant revions |
| Nivbrant 1999 | case control study/Level III | loose hip prosthesis (n = 38), fixed hip arthroplasty (n = 12); OA patients undergoing primary arthroplasty (n = 38) | synovial levels: IL-1B, TNF-a, IL-6 | mean time from implantation for loose prosthetics was 9.8yrs vs. 2.8yrs in fixed implant; excluded patients from analysis if missing data; median data only |
| Kawasaki 2001 | case control study/Level III | loosened hip prosthesis (n = 5), OA patients from primary hip dysplasia (n = 19), osteonecrosis of femoral neck (n = 21) | synovial levels: YKL-40 | average age for OA patients was 48 vs. 63 in loosed implant group; median data only |
| Nildotter 2007 | case control study/Level III | infected hip implants (n = 25), loosened hip implant (n = 60), OA patients undergoing primary arthroplasty (n = 46) | synovial levels: lactate, TNFa, IL-1B, IL-6 serum levels: CRP, ESR, IL-6, TNF-a, IL- 1B | no data provided on serum cytokine levels collected; no comparisons to OA control group provided; excluded patients from analysis if missing data |
| Bottner 2007 | case control study/Level III | septic revision for large joints (n = 21); aseptic revision of large joints (n = 57) | CRP, ESR, IL-6, TNF-a, procalcitonin | Knee/hip revisions: 5/16 for septic, 23/34 for aseptic |
| Frank 2004 | case control study/Level III | staph cultures from prosthetic joint infections compared to coag (-) staph cultures from non-prosthetic joint infections | icaADBC operon | |
| Galdbert 2000 | case control study/Level III | staph epidermidis strains from prosthetic infections (n = 54), staph epidermidis strains from skin flora from 8 healthy individuals | ica operon, biofilm production, genes: clfA, atlE, fbe, fnbA, cna | |
| Di Cesare 2005 | case control study/Level III | 58 patients undergoing reoperation of hip or knee: 17 patients with septic prosthetic infection; 41 patients without evidence of infection | CRP, ESR, IL-6 | |
| Rafiq 2000 | case control study/Level III | patients with prosthetic infection from gram positive organisms (n = 15), control group of 32 patients – 21 with closed fracture, 11 with primary OA | IgG and IgG to lipoteichoic acid | |
| Spangehl 1999 | prospective cohort study/Level II | prospectively evaluated 178 patients undergoing revision hip replacements | determined specificity, sensitivity for CRP, ESR in prosthetic infections | no specific data provided for comparison analysis; excluded patients from analysis if missing data |
| Hall 2001 | prospective study/Level II | 102 patients undergoing primary THA | serum levels: norepinephrine, epinephrine, cortisol, IL-6, CRP; pain, function, and WOMAC3 at 1 and 6 months; | |
| Wozniak 2004 | prospective cohort study/Level II | 33 patients undergoing primary TKA or THA due to OA, divided amongst those experiencing pain (n = 8) and no pain (n = 25) after 2-3 years; 14 healthy controls | neutrophils isolated from peripheral blood and analyzed for NO production – at basline, 2 weeks, 2 months, and 2-3 years post-operatively; | no apparent tool for pain assessment provided; 5/8 reporting pain had evidence of loosening |
| Messiah 1996 | prospective cohort study/Level II | 11 patients undergoing revision TKA; ruled out infection; | synovial LDH levels and correlated to presence of polyethyelene wear | no control group; no apparent standardized method for measurement of polyethyelene wear reported |
| Wilkinson 2003 | case control study/Level III | 20 patients undergoing primary THA or OA; compared development of heterotopic ossification by 26 weeks (n = 9) with those without evidence of such (n = 11) | N-terminal propeptide of type- I procollagen, osteocalcin, bone ALP, C-telopeptide of type-I collagen, urine crosslinked N-telopeptide of type-I collagen and free deoxypridinoline | no control group; only 26 weeks followup for development of heterotopic ossification |
| Ackland 2007 | prospective cohort study/Level II | 129 patients undergoing THA or TKA, divided amongst those with hsCRP >3mg/L (n = 63) and those with hsCRP <3mg/L (n = 66) | length of stay, morbid events |