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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 4, 571-576.
doi: 10.1302/0301-620X.87B4.15316  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Systemic cross-linked N-terminal telopeptide and procollagen I C-terminal extension peptide as markers of bone turnover after total hip arthroplasty

L. Savarino, MSc, Senior Investigator; D. Granchi, MD, PhD, Senior Investigator; E. Cenni, MD, Senior Investigator; N. Baldini, MD, Orthopaedic Surgeon; M. Greco, Technician; and A. Giunti, MD, Professor of Orthopaedic Surgery

Laboratory for Pathophysiology of Orthopaedic Implants, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.

Correspondence should be sent to Dr L. Savarino; e-mail: lucia.savarino{at}ior.it

There is no diagnostic, non-invasive method for the early detection of loosening after total hip arthroplasty. In a pilot study, we have analysed two serum markers of bone remodelling, procollagen I C-terminal extension peptide (PICP) and cross-linked N-terminal telopeptide (NTx), as well as the diagnostic performance of NTx for the assessment of osteolysis. We recruited 21 patients with loosening (group I), 18 with a well-fixed prosthesis (group II) and 17 at the time of primary arthroplasty for osteoarthritis (OA) (group III). Internal normal reference ranges were obtained from 30 healthy subjects (group IV).

The serum PICP level was found to be significantly lower in patients with OA and those with loosening, when compared with those with stable implants, while the NTx level was significantly increased only in the group with loosening, suggesting that collagen degradation depended on the altered bone turnover induced by the implant. This hypothesis was reinforced by the finding that the values in the pre-surgery patients and stable subjects were comparable with the reference range of younger healthy subjects.

A high specificity and positive predictive value for NTx provided good diagnostic evidence of agreement between the test and the clinical and radiological evaluations. The NTx level could be used to indicate stability of the implant. However, further prospective, larger studies are necessary.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General