Our aim was to determine if the serum levels of bone-resorbing
cytokines (IL-1beta, TNF-alpha, IL-6, GM-CSF) are altered in patients with aseptic loosening of a total
hip prosthesis, and if such levels are influenced by the type of implant. We determined
cytokine levels in sera from 35 patients before revision for failed
total hip arthroplasty and compared them with those in 25 healthy donors. We also assessed the soluble receptor of
interleukin-2 (sIL-2r) in serum as an indication of a specific immune reaction against the implant. Our findings showed that the sIL-2r and
TNF-alpha serum level did not change. The
IL-6 level was not significantly altered, but was higher in patients with TiAIV
prostheses than in those with a CrCoMo implant and in patients with cemented
prostheses. The IL-1beta level was found to be higher in those with a TiAIV cemented
prosthesis than in the control group (p=0.0001) and other groups of patients (p=0.003 v uncemented TiAIV, p=0.01 v cemented CrCoMo, p=0.001 v uncemented CrCoMo). The
GM-CSF level significantly increased in patients compared with healthy subjects (p=0.008), and it was higher in those with cemented than with uncemented implants (p=0.01). Only patients with cementless CrCoMo
prostheses had levels of
GM-CSF similar to those of the control group. The highest
GM-CSF concentrations were observed in patients treated with non-steroidal anti-inflammatory drugs (
NSAIDs) in the last months before revision (p=0.04). In addition, when
massive osteolysis was observed, the level of
GM-CSF tended to decrease to that of the control group.