HMGB-1 additional blood test to distinguish Periprosthetic Joint Infection & Aseptic Loosening in TKAs

Ibrahim Halil Rizvanoglu et al conducted a study to investigate the efficiency of High Mobility Group Box-1 protein (HMGB-1) in differentiation of asymptomatic knee prosthesis, and periprosthetic joint infection (PJI) and aseptic loosening (AL) causing painful knee prosthesis.

High mobility group box-1 (HMGB-1) is a member of the alarmin group of cellular messaging proteins that functions as an extracellular signaling molecule by being passively secreted from necrosis cells and actively secreted from cells playing a role in inflammation. HMGB-1 acts as a pro-inflammatory cytokine and a late inflammatory factor in inflammatory processes.

The data of patients who consulted the author’s clinic for checking after total knee arthroplasty surgery were recorded prospectively. Blood levels of CRP, ESR, WBC, and HMGB-1 were recorded.

Blood samples were collected in EDTA coated vacutainer bottles, and centrifuged for 15 min at 1000 g within 1 h of collection. The resulting sera were aliquoted into microtubes and immediately frozen at − 80 °C. These samples were placed into a refrigerator at 4 °C one night before the measurements. Serum samples were kept at room temperature for 2 h before operating with the ELISA method. The samples were then mixed using vortex and measurement procedures were applied.

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.

Key findings of the study were:

• 73 patients were included in the study. Group I (n = 25), including ATKA patients, was considered the control group. Group II (n = 22) comprised the patients diagnosed with PJI, and Group III (n = 26) comprised the patients diagnosed with AL. The distribution of the patients to the groups was similar in terms of age, sex, and operated knee side.

• 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.

• The sensitivity and specificity of HMGB-1 in

Differentiation of ATKA and PJI were 91%, 88%, and

Differentiation of ATKA and AL were 91%, 96%, and

Differentiation of PJI and AL were 81%, 73%.

The authors concluded that – “HMGB-1 may be utilized as an additional blood test even if not alone in the differential diagnosis of problematic knee prosthesis patients. When multicenter studies with larger patient samples are conducted, the role and importance of this marker in diagnosis may increase.”

Further reading:

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

İbrahim Halil Rızvanoglu et al

Indian Journal of Orthopaedics (2023) 57:1023–1031

https://doi.org/10.1007/s43465-023-00903-9