Genetics May Play Role in Whether Joint Replacement Patients Need Revision Surgery: Study

New research suggests an individual’s genetics may be an important factor in the long-term outcomes after a hip or knee replacement, impacting the risk of an individual experiencing aseptic loosening and other complications that may result in joint replacement revision surgery.

Swedish researchers published findings in The Journal of Bone and Joint Surgery on April 6, indicating that the risk of total joint arthroplasty (TJA) revision surgery may be influenced by genetic factors, such as bone formation and blood types.

The findings come as a growing number of Exactech knee replacement lawsuits are being filed by individuals who experienced loosening and failure after receiving certain Optetrak and Truliant knee systems that contained a defective plastic insert, which may deteriorate and fail prematurely, resulting in the need for knee revision surgery.

In the latest study, researchers from the Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden reviewed 1,130 patients who underwent a joint replacement in the hip or knee, for which genetic data was available from the TwinGene project.

Of those who underwent total joint replacement, 8% later underwent revision surgery due to aseptic loosening, which was the leading cause of joint replacement complications. The authors found the most common reason for TJA was primary osteoarthritis, accounting for 84% of all hip arthroplasties and 93% of all knee arthroplasties.

While joint revision surgery was more common after a hip replacement (10.4%) than it was for knee replacement (6.7%), researchers identified 12 unique single-nucleotide polymorphisms (SNP) associated with patients that required revision surgery.

The findings indicate the most commonly found SNPs were those within genes encoding for proteins associated with the inflammatory response, which could provoke response mechanisms that cause aseptic loosening of implants.

The researchers also found ELAPOR2 which regulates the bone morphogenetic protein (BMP) signaling pathways was commonly found among those requiring hip or knee revisions. Tjey determined this could reduce the body’s natural bone remodeling response around implants.

While the study authors indicate additional research is needed to definitively claim a causal relationship between certain genetics and higher risk of knee and hip replacement surgery exist, researchers state the findings are “noteworthy”.