Systemic Inflammatory and Metabolic Risk Factors for Early Periprosthetic Osteolysis After Total Knee Arthroplasty: A Predictive Biomarker Study

Purpose: This study aimed to identify early risk factors for periprosthetic osteolysis after total knee arthroplasty (TKA) and establish clinically useful predictive biomarkers. Methods : A retrospective analysis was conducted on patients who underwent TKA at our institution between January 1, 2018, and October 31, 2023. Initially, 871 patients were screened, and 375 met the inclusion criteria after applying strict eligibility standards. Patients were categorized into an osteolysis group (n=17) and a non-osteolysis group (n=358). Data on baseline characteristics (age, gender, BMI, diabetes, and hypertension history) and postoperative laboratory results were collected. Logistic regression analyses identified independent risk factors for osteolysis, with subgroup analyses also performed. Results : Multivariate logistic regression analysis identified elevated leukocyte count (OR=1.47, 95%CI: 1.19-1.80, P<0.001), BMI (OR=1.24, 95%CI: 1.03-1.49, P=0.021), and FIB-4 index (OR=2.08, 95%CI: 1.23-3.52, P=0.006) as significant positive risk factors, while the uric acid-to-creatinine ratio (UACR) was negatively associated (OR=0.51, 95%CI: 0.31-0.82, P=0.006). Subgroup analyses revealed variations in these risk factors across gender, age, diabetes, and hypertension status. Conclusion : This study demonstrates that leukocyte count, BMI, FIB-4 index, and UACR are independent risk factors for early periprosthetic osteolysis after TKA. These findings may assist in the early identification and management of high-risk patients, thereby reducing postoperative complications and improving patient outcomes.