Emerging applications of proteomics in hip and knee arthroplasty

Abstract

Total hip and knee arthroplasties are commonly performed orthopedic procedures that involve a complex interaction between the prosthetic device and its surrounding biological environment. Recent developments in the field of proteomics have enabled a better understanding of these interactions in patients with a total joint arthroplasty and have the potential to lead to development of novel diagnostic and therapeutic modalities that may improve the care of these patients, particularly those who have developed complications of wear, osteolysis, loosening and periprosthetic joint infection. This article reviews several of the areas of active research that are occurring at the intersection of the fields of proteomics and total joint arthroplasty.

Keywords::

• biomarker
• cytokine
• loosening
• osteolysis
• periprosthetic joint infection
• total hip arthroplasty
• total knee arthroplasty

Financial & competing interests disclosure

The author is a paid consultant for Smith & Nephew Orthopaedics. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed and widely successful orthopedic procedures.

• Wear, osteolysis and mechanical loosening are known long-term limitations of these devices.

• Research tools such as flow cytometry, ELISA and high-throughput protein chips have allowed a better understanding of the cytokine-driven cascades that mediate the cellular pathways of wear, osteolysis and loosening.

• Various proteins, cytokines and biomarkers are elevated in either the serum or synovial fluid of patients with aseptic loosening or periprosthetic osteolysis.

• Periprosthetic joint infection remains a significant clinical problem following THA and TKA, and a diagnosis of low-grade infection can often be elusive using traditional testing modalities.

• Synovial fluid biomarker analysis has identified a number of proteins that offer excellent sensitivity, specificity and accuracy in the diagnosis of periprosthetic joint infection, which hold significant clinical promise as testing for these becomes more widely available.

• Proteomics may offer the potential to identify and predict the risk of various perioperative complications following total joint arthroplasty.

• Measurement of serum biomarkers and proteins that serve as a surrogate for surgical stress and muscle damage has allowed comparison of various surgical techniques for performing THA and TKA, which has provided some definitive evidence toward the benefit of minimally invasive surgical approaches for THA and TKA.