title: Are there biological markers for wear or corrosion? A systematic review.
abstract: BACKGROUND
  Identification of biomarkers associated with wear and tribocorrosion in joint arthroplasty would be helpful to enhance early detection of aseptic loosening and/or osteolysis and to improve understanding of disease progression. There have been several new reports since the last systematic review (which covered research through mid-2008) justifying a new assessment.
  
  
  OBJECTIVE
  We sought to determine which biomarkers have the most promise for early diagnosis and monitoring of aseptic loosening and/or osteolysis related to wear or corrosion in total joint arthroplasty.
  
  
  METHODS
  We performed a systematic review using MEDLINE and EMBASE databases, covering the period through December 2013, and identified 1050 articles. We restricted the definition of biomarker to biomolecules and imaging parameters useful for diagnosis and monitoring of disease progression, only including articles in English. We chose 65 articles for full review, including 44 from the original search and 21 from subsequent hand searches. We used the 22 articles in which patients with total joint arthroplasty who had aseptic loosening and/or periimplant osteolysis unrelated to sepsis had been compared with patients with total joint arthroplasty with stable implants. There were 90 comparisons of these two patient populations involving 35 different biomarkers.
  
  
  RESULTS
  Diagnostic accuracy was assessed in nine of the 90 comparisons with the highest accuracy found for tartrate-resistant acid phosphatase 5b (0.96), although a separate comparison for this biomarker found a lower accuracy (0.76). Accuracy of > 0.80 was also found for crosslinked n-telopeptide of type I collagen, osteoprotegerin, and deoxypyridinoline. The most studied markers, tumor necrosis factor-α and interleukin-1β, were found to differ in the affected and control groups in < 30% of the comparisons. Thirty of the 35 biomarkers were studied in four or fewer separate comparisons with nearly half of the biomarkers (17) studied in only one comparison. Many of the comparisons were not able to eliminate a number of confounding variables, and there was only one prospective study.
  
  
  CONCLUSIONS
  Currently, there are no validated biomarkers for early diagnosis and monitoring of the biological sequelae of wear or tribocorrosion, although there are some promising leads, including markers of bone turnover.
authors.affiliation: Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina, Suite 507, Chicago, IL, 60612, USA, rick_sumner@rush.edu.
authors.forename: D Rick
authors.initials: DR
authors.lastname: Sumner
authors.forename: Ryan
authors.initials: R
authors.lastname: Ross
authors.forename: Ed
authors.initials: E
authors.lastname: Purdue
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation*; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D003343:Corrosion; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D007595:Joint Prosthesis; D007596:Joints / Q000503:physiopathology / Q000601:surgery*; D010014:Osteolysis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D013314:Stress, Mechanical; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers