An understanding of the pathogenesis of aseptic loosening is critical to its prevention. Though many studies have focused on the increase in bone resorption, few have examined osteoblastic activity in loosened arthroplasties. In this study, alkaline phosphatase and osteocalcin, two well-described osteoblast markers, were measured in synovial fluid samples from patients with either primary osteoarthrosis (OA) or failed hip replacements. Osteocalcin levels were significantly reduced in failed arthroplasties as compared to primary OA (p < 0.05) with mean (SEM) values of 3.13 ng/ml (0.874) and 6.84 ng/ml (1.24) respectively. The mean (SEM) alkaline phosphatase activity was 0.436 mol/ml/15min (0.127) in revisions and 0.712 (0.199) in primary OA (NS). There was poor correlation between osteocalcin concentration and alkaline phosphatase activity (r =0.16, p<0.05). These data suggest that in addition to enhanced bone resorption, osteoblastic bone formation may also be reduced in periprosthetic bone and as such may play a key role in the pathogenesis of aseptic loosening.
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