Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy.
J Orthop Res. 2010 Jul;28(7):887-92. doi: 10.1002/jor.21082.
In a cohort study, the role of the active tartrate-resistant acid phosphatase (TRACP 5b), a marker of bone-resorbing osteoclasts, for the assessment of loosening after total hip arthroplasty (THA), was analyzed, as well as its correlation with osteolysis and multinucleated cell appearance in the retrievals. Eighty THA patients, who went consecutively to the orthopedic department, were asked to participate, and 54 accepted and were enrolled in the study. Finally, 46 subjects were analyzed, clinical-radiographic evaluation was considered the gold standard, serum TRACP 5b was blindly measured, and a cut-off was obtained, by performing a ROC Curve. Based on the gold standard, patients were split by 19 stable and 27 loosened subjects, and results were matched. TRACP 5b was significantly higher in loosened patients than in stable ones (p < 0.001). A good specificity (89.5%), positive predictive value (90.0%), and likelihood ratio (6.33) were calculated, that provided strong evidence of loosening with TRACP 5b levels higher than the cut-off. Moreover, TRACP 5b and osteolysis (Fisher's exact test, p = 0.03) were found significantly correlated. TRACP 5b has been proven a reliable marker, specifically related to resorbing-multinucleated cells, to ascertain late loosening in THA, and could support standard procedures, if confirmed by performing prospective studies.
在一项队列研究中，分析了活性抗酒石酸酸性磷酸酶（TRACP 5b）在全髋关节置换术后（THA）松动评估中的作用，该酶是骨吸收破骨细胞的标志物，以及其与取出物中的溶骨和多核细胞外观的相关性。连续到骨科就诊的 80 名 THA 患者被要求参加，其中 54 名接受并被纳入研究。最后，对 46 名患者进行了分析，临床影像学评估被认为是金标准，盲法测量了血清 TRACP 5b，并通过 ROC 曲线获得了一个截断值。根据金标准，将患者分为 19 例稳定和 27 例松动的患者，并进行匹配。松动患者的 TRACP 5b 明显高于稳定患者（p < 0.001）。计算出了良好的特异性（89.5%）、阳性预测值（90.0%）和似然比（6.33），这有力地证明了 TRACP 5b 水平高于截断值与松动有关。此外，TRACP 5b 与溶骨（Fisher 确切检验，p = 0.03）显著相关。TRACP 5b 已被证明是一种可靠的标志物，与吸收多核细胞特异性相关，可确定 THA 的晚期松动，如果通过前瞻性研究得到证实，它可以支持标准程序。
