Biomarkers of Inflammation and Thrombosis in Patients Undergoing Total Joint Replacement

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Introduction Osteoarthritis (OA) is the most common joint disorder in the United States. It is a type of arthritis caused by the damage or breakdown of cartilage in the joints and common in the hips, knees, and hands. OA symptoms include swelling, stiffness, or pain in the joints and, in some cases, can cause the inability to do everyday tasks. The treatment for osteoarthritis includes medications (nonsteroidal anti-inflammatory), lifestyle changes (weight loss), physical therapy, or surgery (total joint replacement). However, after Total Joint Replacement surgery, there is a risk of developing thrombosis. This study was designed to measure the biomarkers of inflammation and thrombosis in patients undergoing total knee (TKA) and hip (THA) arthroplasty. Materials and Methods: Blood samples from 72 patients were collected from EDTA anticoagulants from Loyola University Hospital laboratories and processed for preparing plasma which was frozen in aliquots for future analysis. Control represented plasma samples prepared from EDTA anticoagulated blood from 5 healthy individuals (NHP). Plasma samples were analyzed for D-dimers, PAI-1, and vWF by using a commercially available ELISA kits. All results were analyzed by mean + standard deviation. Statistical analysis was carried out by using PRISM GraphPad software. Results Patients undergoing total joint arthroplasty showed elevated levels of D-Dimer (4726.2 vs 115.1 ng/ml, p value <0.001), PAI-1 (49.8 vs 16.9 ng/ml, p value<0.001) and vWF (125.5 vs 104.1 %, p value <0.001) in comparison to NHP. No correlation between these markers were noted. Conclusion Elevated levels of D-Dimer indicate increased thrombin generation, hemostatic dysregulation. Increase in PAI-1 levels indicate fibrinolytic deficit and elevated vWF suggest endothelial dysfunction. These results suggest that the pathogenesis include thrombogenesis and inflammatory responses. Measurement of these markers can be useful in the risk stratification of OA patients.