title: Is tartrate-resistant acid phosphatase 5b a potent bio-marker for late stage aseptic implant loosening?
abstract: OBJECTIVE
  Aseptic loosening is a serious complication after total joint arthroplasty. Plain radiography, along with clinical signs of prosthesis loosening, is the technique of first choice to evaluate loosening of joint replacements. Nevertheless, radiographical signs of osteolysis may not be apparent until progressed stages of loosening. Thus the search for alternative diagnostic methods is of great importance. The purpose of the present study was to evaluate the potential diagnostic significance of TRAP 5b, Osteocalcin, CrossLaps and Bone ALP for aseptic loosening of total joint replacements.
  
  
  METHODS
  Thirty-seven patients (25 women, 12 men, mean age 65 years, age range 54-76 years) treated with revision surgery due to clinically and radiologically confirmed late aseptic prosthesis loosening were examined prospectively. Serum levels of TRAP 5b, Osteocalcin, CrossLaps and Bone ALP were compared with a matched control group (n = 39).
  
  
  RESULTS
  We found a significant decrease in TRAP 5B level in patients with aseptic loosening. Bone ALP and Osteocalcin as markers of osteoblast activity, and CrossLaps as another resorption marker did not allow any prediction of bone remodeling in this late phase of loosening.
  
  
  CONCLUSIONS
  In the "late" phase of aseptic joint replacement loosening, no increase of TRAP 5b and therefore no increase of osteoclast number and activity was measurable. Thus, in this situation an anti-osteolytic therapy with a bisphosphonate or denosumab would not gain any further benefit.
authors.affiliation: Department of Trauma Surgery, Justus-Liebig-University, Giessen, Germany.
authors.forename: Gerrit Steffen
authors.initials: GS
authors.lastname: Maier
authors.forename: Christian
authors.initials: C
authors.lastname: Eberhardt
authors.forename: Marco
authors.initials: M
authors.lastname: Strauch
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kafchitsas
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Kurth
mesh_terms: D000135:Acid Phosphatase / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D016723:Bone Remodeling; D002452:Cell Count; D003094:Collagen / Q000032:analysis*; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood*; D010010:Osteoclasts; D010446:Peptide Fragments / Q000032:analysis*; D011475:Prosthesis Failure; D000071681:Tartrate-Resistant Acid Phosphatase
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D010446:Peptide Fragments; C110762:glutamyl-lysyl-alanyl-histidyl-aspartyl-glycyl-glycyl-arginine; D015675:Osteocalcin; D003094:Collagen; D000135:Acid Phosphatase; D000071681:Tartrate-Resistant Acid Phosphatase
references.citation: J Endocrinol Invest. 2005;28(10 Suppl):8-13
references.pmid: 16550716
references.citation: J Bone Miner Res. 2003 Jan;18(1):134-9
references.pmid: 12510815
references.citation: J Biol Chem. 1999 Aug 13;274(33):22907-10
references.pmid: 10438453
references.citation: J Arthroplasty. 2001 Dec;16(8 Suppl 1):177-82
references.pmid: 11742472
references.citation: Calcif Tissue Int. 2002 Jul;71(1):20-5
references.pmid: 12073156
references.citation: Injury. 2011 Aug;42(8):758-64
references.pmid: 21168135
references.citation: Z Orthop Ihre Grenzgeb. 2001 May-Jun;139(3):240-4
references.pmid: 11486627
references.citation: J Bone Miner Res. 2000 Jul;15(7):1337-45
references.pmid: 10893682
references.citation: Bone. 2014 Sep;66:46-55
references.pmid: 24909537
references.citation: Clin Orthop Relat Res. 2006 Dec;453:299-304
references.pmid: 16906105
references.citation: J Bone Miner Res. 1996 Oct;11(10):1444-52
references.pmid: 8889844
references.citation: Arch Orthop Trauma Surg. 2010 Apr;130(4):441-5
references.pmid: 19513735
references.citation: J Orthop Res. 2003 Jul;21(4):691-6
references.pmid: 12798070
references.citation: J Orthop Res. 2014 Jul;32(7):967-73
references.pmid: 24604767
references.citation: J Bone Joint Surg Br. 2005 Jun;87(6):781-5
references.pmid: 15911658
references.citation: Acta Orthop. 2007 Apr;78(2):221-5
references.pmid: 17464610
references.citation: Am J Kidney Dis. 2003 May;41(5):1052-9
references.pmid: 12722040
references.citation: Acta Orthop Scand. 1993 Oct;64(5):497-506
references.pmid: 8237312
references.citation: J Orthop Res. 2010 Jul;28(7):887-92
references.pmid: 20063383
references.citation: Int Orthop. 2009 Feb;33(1):77-82
references.pmid: 18084760