HMGB-1 Levels in Painful Knee Arthroplasty: Is it Possible to Distingue Periprosthetic Joint Infection and Aseptic Loosening?

Introduction

We investigated the efficiency of high mobility group box-1 protein (HMGB-1) in differentiation of asymptomatic knee prosthesis, and periprosthetic joint infection and aseptic loosening causing painful knee prosthesis.

Materials and Methods

The data of patients who consulted our clinic for checking after total knee arthroplasty surgery were recorded prospectively. Blood levels of CRP, ESR, WBC, and HMGB-1 were recorded. Patients whose examination and routine tests were within normal limits comprised group I, asymptomatic total knee arthroplasty (ATKA). Painful patients with abnormal test results underwent three phase bone scintigraphy for further investigation Patients with periprosthetic joint infection (PJI) and aseptic loosening (AL) according to scintigraphy comprised group II and group III, respectively. The mean values of HMGB-1 and cut-off values according to the groups and their correlations with other inflammatory parameters were determined.

Results

Seventy-three patients were included in the study. Significant differences were observed in three groups, in terms of CRP, ESR, WBC, and HMGB-1. The cut-off value of HMGB-1 was determined as 15.16 ng/ml between ATKA and PJI, 16.92 ng/ml between ATKA and AL, and 27.87 ng/ml between PJI and AL, respectively. Accordingly, the sensitivity, and specificity of HMGB-1 in differentiation of ATKA and PJI were 91%, 88%, and in differentiation of ATKA and AL were 91%, 96%, and in differentiation of PJI and AL were 81%, 73%, respectively.

Conclusion

HMGB-1 may be utilized as an additional blood test in the differential diagnosis of problematic knee prosthesis patients.

AST/ALT ratio as a potential predictor of 1-year mortality in elderly patients operated for femoral neck fracture

PURPOSE

Hip fractures in elderly individuals are associated with high mortality rates, even with advanced treatment options. Identifying factors correlated with mortality could guide potential preventive strategies. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, as well as the AST/ALT ratio (AAR), have been associated with mortality in various diseases, but their association with hip fracture mortality remains underexplored. This study investigates the correlation between AST, ALT, AAR, and routine laboratory parameters with 1-year mortality in elderly patients undergoing partial hip arthroplasty for femoral neck fractures.

METHODS

This retrospective cohort study analyzed data from 179 elderly patients (≥60 years) who underwent partial hip replacement for femoral neck fracture between January 2019 and December 2021.

RESULTS

Of the 179 patients, 29.6% died within one year of surgery. The deceased patients were older, predominantly male, and had higher rates of postoperative complications and transfusions. Univariate analysis identified age, sex, blood type, comorbidities, postoperative complications, transfusions, and laboratory parameters (including AAR, creatinine, and lymphocyte count) as associated with mortality. Multivariate analysis further highlighted advanced age, male sex, blood group A, postoperative transfusions, elevated creatinine levels, and high AAR (>2.1) as independent predictors of mortality.

CONCLUSION

Our findings suggest that preoperative AAR may serve as an independent predictor of mortality in elderly patients undergoing hip fracture surgery, highlighting its potential utility in preoperative risk stratification.