Clinical Orthopaedics and Related Research®

, Volume 472, Issue 2, pp 584–589

Elevation of Serum Tumor Necrosis Factor α in Patients with Periprosthetic Osteolysis: A Case-Control Study

  • R. Krishna Chaganti
  • Edward Purdue
  • Thomas P. Sculco
  • Lisa A. Mandl
Symposium: 2013 Hip Society Proceedings

DOI: 10.1007/s11999-013-3235-9

Cite this article as:
Chaganti, R.K., Purdue, E., Sculco, T.P. et al. Clin Orthop Relat Res (2014) 472: 584. doi:10.1007/s11999-013-3235-9



Periprosthetic osteolysis is the leading reason for THA revision. The relationship of serum biomarkers with severe radiographic periprosthetic osteolysis has not been defined but may be important to direct future research and clinical therapeutics.


We determined whether there was an association between measurable inflammatory markers (high-sensitivity C-reactive protein [hsCRP]) or inflammatory mediators (tumor necrosis factor α [TNF-α], IL-1β, IL-6, receptor activator of nuclear factor κB ligand [RANKL], and osteoprotegerin [OPG]) and periprosthetic osteolysis.


We identified 15 patients with THAs scheduled for revision surgery because of severe periprosthetic osteolysis. For each study patient, a nonosteolytic, pain-free control patient with THAs was identified and matched for age, sex, time since initial THA, acetabular and femoral component prosthesis material, and prosthesis wear within 1.0 mm/year using a manual wear analysis technique. Overall, the study and control patients had a mean wear rate of 0.25 mm/year since index THA. There were no differences in baseline characteristics between study and control patients in age, sex, BMI, Charlson Comorbidity Index, time since initial THA, UCLA activity score, and acetabular and femoral component type. Serum hsCRP, IL-1β, IL-6, TNF-α, RANKL, and OPG were measured by ELISA in duplicate assays. Differences in values were assessed using the Wilcoxon rank-sum test.


Median TNF-α levels were higher in study patients than in controls (7.1 pg/mL [SD, 11.6 pg/mL] versus 1.5 pg/mL [SD, 1.3 pg/mL]) (p < 0.01). Median IL-6 levels tended to be higher in study patients than in controls (8.9 pg/mL [SD, 13.2 pg/mL] versus 3.5 pg/mL [SD, 0.7 pg/mL]) (p = 0.09). The other serum inflammatory proteins and mediators of bone turnover were not different between groups.


TNF-α is elevated in patients with osteolysis compared to matched controls. The role of TNF-α and its potential as a target of nonsurgical therapy to prevent osteolysis warrant further investigation in larger, prospective studies.

Level of Evidence

Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • R. Krishna Chaganti
    • 1
  • Edward Purdue
    • 2
  • Thomas P. Sculco
    • 2
  • Lisa A. Mandl
    • 3
  1. 1.Division of RheumatologyUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of OrthopedicsHospital of Special SurgeryNew YorkUSA
  3. 3.Division of Rheumatology Hospital for Special SurgeryNew YorkUSA

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