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Toll-like receptors may serve as biomarkers for deep infection of periprosthetic tissues

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NEW ORLEANS – The increased expression of toll-like receptor 1 in periprosthetic tissues may help in the accurate diagnosis of periprosthetic joint infection in patients who undergo total joint replacement, according to data presented here at the American Academy of Orthopaedic Surgeons Annual Meeting.

“These biomarkers might be especially helpful in detecting culture-negative infections and avoiding false positives resulting from contamination. So we are therefore moving forward in testing these biomarkers in synovial fluid,” Cara A. Cipriano, MD, said.

Cipriano presented results of a pilot study, which analyzed the expression of toll-like receptor (TLR) 1 in periprosthetic tissues of patients who underwent revision total hip and total knee arthroplasty. Of the 49 patients available for study, 17 patients were designated as infected and 21 patients as noninfected. Seven patients were classified as having an uncertain periprosthetic joint infection (PJI) status and 4 patients were persistently infected after surgical and antibiotic treatment.

Researchers collected synovium and interface membranes intraoperatively and extracted total RNA. The expression of mRNAs for TLRs was assessed by first strand cDNA synthesis followed by real-time polymerase chain reaction.

Mean levels of TLR expression in the infected and noninfected groups were compared. The team calculated receiver operating characteristic curves, area under the curves, sensitivity and specificity to determine the accuracy of each TLR in the prediction of PJI at the optimal diagnostic threshold.

The researchers found TLR 1 expression had 94.4% sensitivity and 95.5% specificity in the prediction of PJI. Mean levels of TLR 1 and TLR 6 mRNA expression increased in the infected group compared to the noninfected group. TLR 10 expression was not different between the groups. Mean levels of TLR 1 and TLR 6 in the uncertain infection status and persistently infected groups were lower than in the infected group but higher than in the noninfected group.

Reference:

Cipriano CA. Paper #46. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

Disclosure: Cipriano has no relevant financial disclosures.