Analysis of serological markers and synovial fluid cytology in aseptic revision total knee arthroplasty.
5 affiliations
- 1The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. [email protected].
- 2Department of Orthopedic Surgery, New York University Langone Medical Center, New York, USA. [email protected].
- 3Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel. [email protected].
- 4Department of Orthopedic Surgery, New York University Langone Medical Center, New York, USA.
- 5Department of Orthopedic Surgery, New York University Langone Medical Center, New York, USA. [email protected].
Abstract
Background and aim
Recent studies examining synovial fluid analysis to differentiate causes for aseptic revision total knee arthroplasty (rTKA) were limited to aseptic loosening and instability. This study aims to establish specific serological and synovial profiles for various rTKA etiologies.Methods
We retrospectively reviewed patients who underwent aseptic rTKA at a single academic institution between 2012 and 2023. Inclusion required complete serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and synovial fluid differentials within three months pre-operatively. Periprosthetic joint infections were strictly excluded utilizing the 2018 International Consensus Meeting criteria. In total, 156 patients were included and stratified into five aseptic etiologies: aseptic loosening (50.6%), instability (28.2%), arthrofibrosis (16.7%), liner wear (2.6%), and component malposition (1.9%). Serological markers were evaluated utilizing a multivariate general linear model adjusting for patient demographics, while synovial markers were assessed via Welch's Analysis of Variance (ANOVA) and Games-Howell post-hoc testing.Results
Multivariate analysis demonstrated that the underlying rTKA indication was not a significant independent predictor of elevated ESR (P = 0.661) or CRP (P = 0.947). Welch's ANOVA revealed significant differences in the percentage of synovial monocytes (P < 0.001) and lymphocytes (P = 0.010), alongside the polymorphonuclear cells/monocyte (P = 0.030) and lymphocyte/monocyte (P = 0.005) ratios. Games-Howell post-hoc testing demonstrated the tibial liner wear group exhibited significantly higher monocyte percentages, paired with lower lymphocyte percentages and cellular ratios, compared to other aseptic etiologies.Conclusions
This study revealed that routine systemic inflammatory markers and standard synovial fluid cell counts do not significantly vary among the common etiologies of aseptic rTKA. Nonetheless, tibial polyethylene liner wear appears to elicit an exploratory, monocyte-predominant and lymphocyte-depleted local macrophage response that is absent in other mechanisms of aseptic failure. Further research with larger cohorts is warranted to validate this association and explore its potential as a diagnostic tool.
Related
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- Comparing Short-Term Clinical Outcomes and Survivorship of Complex Revision Total Hip Arthroplasty: Custom Triflange Acetabular Implants Vs Standard Cage Reconstruction
- Early Revision Rates and Clinical Outcomes of Two Cementless Cruciate-Retaining Total Knee Arthroplasty Designs at Two-Year Follow-Up: A Propensity Score-Adjusted Comparative Analysis
- Use of a high-speed pencil-tip burr for removal of well-fixed humeral components in revision shoulder arthroplasty
- Prognosis of 1st time revision due to pain following primary total hip arthroplasty - a nationwide cohort study from the Danish Hip Arthroplasty Register
BibTeX
@article{khury2026analysis,
title = {{Analysis of serological markers and synovial fluid cytology in aseptic revision total knee arthroplasty.}},
author = {Farouk Khury and Jack Zhong and Garrett Ruff and Anzar Sarfraz and Laith Bahlouli and Vinay K Aggarwal and Ran Schwarzkopf},
journal = {Archives of orthopaedic and trauma surgery},
year = {2026},
month = oct,
doi = {10.1007/s00402-026-06536-5},
url = {https://europepmc.org/article/MED/42902091},
note = {CC BY},
}
RIS
TY - JOUR
TI - Analysis of serological markers and synovial fluid cytology in aseptic revision total knee arthroplasty.
AU - Farouk Khury
AU - Jack Zhong
AU - Garrett Ruff
AU - Anzar Sarfraz
AU - Laith Bahlouli
AU - Vinay K Aggarwal
AU - Ran Schwarzkopf
PY - 2026
DA - 2026/10/20
JO - Archives of orthopaedic and trauma surgery
DO - 10.1007/s00402-026-06536-5
UR - https://europepmc.org/article/MED/42902091
AB - Background and aim Recent studies examining synovial fluid analysis to differentiate causes for aseptic revision total knee arthroplasty (rTKA) were limited to aseptic loosening and instability. This study aims to establish specific serological and synovial profiles for various rTKA etiologies.Methods We retrospectively reviewed patients who underwent aseptic rTKA at a single academic institution between 2012 and 2023. Inclusion required complete serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and synovial fluid differentials within three months pre-operatively. Periprosthetic joint infections were strictly excluded utilizing the 2018 International Consensus Meeting criteria. In total, 156 patients were included and stratified into five aseptic etiologies: aseptic loosening (50.6%), instability (28.2%), arthrofibrosis (16.7%), liner wear (2.6%), and component malposition (1.9%). Serological markers were evaluated utilizing a multivariate general linear model adjusting for patient demographics, while synovial markers were assessed via Welch's Analysis of Variance (ANOVA) and Games-Howell post-hoc testing.Results Multivariate analysis demonstrated that the underlying rTKA indication was not a significant independent predictor of elevated ESR (P = 0.661) or CRP (P = 0.947). Welch's ANOVA revealed significant differences in the percentage of synovial monocytes (P < 0.001) and lymphocytes (P = 0.010), alongside the polymorphonuclear cells/monocyte (P = 0.030) and lymphocyte/monocyte (P = 0.005) ratios. Games-Howell post-hoc testing demonstrated the tibial liner wear group exhibited significantly higher monocyte percentages, paired with lower lymphocyte percentages and cellular ratios, compared to other aseptic etiologies.Conclusions This study revealed that routine systemic inflammatory markers and standard synovial fluid cell counts do not significantly vary among the common etiologies of aseptic rTKA. Nonetheless, tibial polyethylene liner wear appears to elicit an exploratory, monocyte-predominant and lymphocyte-depleted local macrophage response that is absent in other mechanisms of aseptic failure. Further research with larger cohorts is warranted to validate this association and explore its potential as a diagnostic tool.
SN - 0936-8051
SN - 1434-3916
ER -