Association of blood parameters and ratios with aseptic loosening after total knee arthroplasty

This study aimed to evaluate the association of blood parameters and ratios with knee prosthesis loosening in patients after knee arthroplasty. A total of 221 patient files having knee prosthesis attempting to our clinic between 2018 and 2022 were retrospectively examined. Patients were divided into 2 groups as loosening (n = 108; 48.9%) and not loosening (n = 113; 51.1%) groups. Monocyte/high-density lipoprotein (HDL) ratio monocyte-to-HDL ratio (MHR), Neutrophil/lymphocyte ratio, Albumin/ C-reactive protein (CRP) ratio, albumin-to-C-reactive protein ratio (ACR), Eosinophile-to- lymphocyte ratio, mean platelet volume /PLT ratio mean platelet volume-to-platelet ratio, Monocyte -to-lymphocyte ratio, Platelet/lymphocyte ratio (PLR) and Hemoglobin/Platelet ratio (HPR) parameters of patients were evaluated. HDL, albumin, hemoglobin, ACR, PLR and HPR levels were significantly higher in loosening patients (P < .05). CRP, neutrophile, lymphocyte, monocyte and MHR means were significantly higher in no-loosening patients (P < .05). Loosening was significantly correlated with gender (R = 0.141; P < .05), HDL (R = 0.474; P < .01), albumin (R = 0.349; P < .01), CRP (r = -0.466; P < .01), neutrophile (r = -0.167; P < .05), lymphocyte (r = -0.240; P < .01), monocyte (r = -0.380; P < .01), hemoglobin (R = 0.254; P < .01), MHR (r = -0.513; P < .01), ACR (R = 0.496; P < .01), PLR (R = 0.142; P < .05) and HPR (R = 0.204; P < .01). Binary logistic regression analysis showed that MHR (B = -0.415; P < .01), ACR (B = 0.048; P < .01), and HPR (B = 30.640; P < .05) were significantly associated with knee prosthesis loosening at the multivariate level. ROC analysis demonstrated statistically significant discriminative performance for MHR, area under the curve ([AUC] = 0.798; P < .01), ACR (AUC = 0.786; P < .01), and HPR (AUC = 0.618; P < .01). For MHR 6.2481 cutoff level, sensitivity was 72.2% and specificity was 10.6%. For ACR 8.6380 cutoff level, sensitivity was 84.3% and specificity was 59.3%. For HPR 0.0506 cutoff level, sensitivity was 63.9% and specificity was 54.0%. MHR, ACR, and HPR were significantly associated with aseptic loosening after total knee arthroplasty and may be considered potential associated markers rather than definitive predictors.