2023, Vol. 27 ›› Issue (27): 4304-4311

Dynamic monitoring of plasma human alpha-defensin 1-3 and peripheral blood inflammatory markers after primary total knee arthroplasty

Chen Jinlun1, 2, Deng Peng1, Ye Pengcheng1, Cao Houran3, Zeng Huiliang4, Feng Wenjun1, Zeng Jianchun1, Zeng Yirong1   

Abstract: BACKGROUND: Previous studies demonstrated that synovial fluid human α-defensin 1-3 can provide a high accuracy for diagnosing periprosthetic joint infection. However, arthrocentesis is an invasive manipulation that repeated examination may increase the risk of developing periprosthetic joint infection and confuse the orthopedists on the cause and onset time of the disease so that it is unsuitable for conventional dynamic detection after total knee arthroplasty. Oppositely, peripheral blood tests have the advantages of micro-trauma, convenient access to samples and possibility of continuous and dynamic monitoring. However, no study about the changes of human α-defensin 1-3 content in plasma following primary total knee arthroplasty has been published by now.  
OBJECTIVE: To observe the dynamic changes of human α-defensin 1-3 content in plasma and inflammatory marker levels in peripheral blood following primary total knee arthroplasty, so as to provide a new method for early screening for periprosthetic joint infection after total knee arthroplasty.
METHODS: From April to December 2015, patients who had undergone unilateral primary total knee arthroplasty because of advanced knee osteoarthritis were prospectively included in the study. The inflammatory marker levels in peripheral blood were tested on the preoperative day and postoperative 1, 3, 5 days, 2 weeks, 1, and 3 months. Sandwich enzyme-linked immunosorbent assay was used to detect the content of plasma human α-defensin 1-3.  
RESULTS AND CONCLUSION: Finally, 27 patients were included in the study. The postoperative level of C-reactive protein and erythrocyte sedimentation rate in peripheral blood showed a rise first followed by a decline defined single-peaked change pattern. The content of white blood cell, neutrophil and neutrophil percentage in peripheral blood and human α-defensin 1-3 in plasma showed a double-peaked change pattern. That was, after the arthroplasty, it first rose and then fell, and then rose again and then fell again. The changing rate and extent of plasma human α-defensin 1-3 were more obvious than peripheral blood white blood cell, neutrophil and neutrophil percentage. The prominent “bimodal situation” suggests that plasma human α-defensin 1-3 may be a good biomarker for dynamic monitoring of inflammatory activity after total knee arthroplasty, which provides new ideas and evidence for monitoring and diagnosing periprosthetic infection after total knee arthroplasty.

Key words: total knee arthroplasty, periprosthetic joint infection, dynamic change, plasma human alpha defensin