Genetics may help to predict the risk of joint replacement rejection, a recent study suggests.
The research aimed to establish whether genetics could be a factor influencing the increasing number of joint replacement rejections. The team used genetic data from over 600 patients that had undergone joint replacement therapy to determine whether certain genetic traits at certain genes could increase the risk of joint replacement rejection.
'A large percentage of joint failures are due to adverse immune responses, where small particles from the joint implant are released into the blood through wear and tear, stimulating an immune response in the body.' said lead author and director of ExplantLab, Dr David Langton.
Over five million joint replacements are carried out annually worldwide. This figure is set to double in the next two decades, exacerbated by an increasingly old and heavy population. One of the most popular materials, used in over 70 percent of joint replacements, is cobalt chrome (CoCr). When small CoCr particles are released into the blood, it can trigger an immune response resulting in pain and joint failure in some patients. Research carried out over the last three decades had previously implicated human leukocyte antigen (HLA) genes in metal sensitivity through their role in the immune system. This study took the previous findings one step further and considered specific HLA genotypes.
The team, who published their results in Communications Medicine, collected saliva samples from 606 participants. Sequencing results found significant associations between three specific HLA genotypes and susceptibility to joint replacement rejection.
Additionally, the team also produced an algorithm, called Orthotype, capable of using genotype data to predict a patient's risk of developing metal sensitivity. The algorithm was able to detect the above susceptibility genotypes with over 90 percent accuracy.
The authors said: 'Orthotype helps to identify patients and understand the risks prior to surgery, representing a significant advance in orthopaedic care for patients, and a step-change for orthopaedic surgeons, with potentially significant financial repercussions for global healthcare systems, through the avoidance of repeat surgery.'
The authors also note that delineating the results is somewhat complicated by patient sex and the amount of metal ions produced. Women were found to be more susceptible to implant rejection even when exposed to similar amounts of metal ions as men. Additionally, lower rates of rejection were found in some patients who possessed higher risk haplotypes but had low blood metal ion concentrations.
'This represents a significant advance in orthopaedic care for patients,' said Dr Langton, 'with potentially significant financial repercussions for global healthcare systems, through the avoidance of repeat surgery.'
The authors hope their algorithm can help inform the selection of implant, based on the manufactured material most suited to the patient. Post-operatively, it can be used in conjunction with the measurement of metal concentrations, to allow assessment of clinical prognosis.
Sources and References
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Newcastle scientists discover link between genetics and failure of joint replacements
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The influence of HLA genotype on the development of metal hypersensitivity following joint replacement
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Gene test to tell if your hip surgery will fail: Saliva swab could predict if you'll have an adverse reaction to a joint implant
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Genetic basis for joint replacement failure
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