Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

被引:196
作者
Goodman, Stuart B. [1 ,2 ]
Gallo, Jiri [3 ,4 ]
机构
[1] Stanford Univ, Dept Orthopaed Surg, 450 Broadway St M-C 6342, Redwood City, CA 94063 USA
[2] Stanford Univ, Dept Bioengn, Stanford, CA 94305 USA
[3] Palacky Univ Olomouc, Fac Med & Dent, Dept Orthopaed, IP Pavlova 6, Olomouc 77900, Czech Republic
[4] Univ Hosp Olomouc, IP Pavlova 6, Olomouc 77900, Czech Republic
关键词
Total joint replacement; total hip arthroplasty; total knee arthroplasty; periprosthetic osteolysis; aseptic loosening; debris-induced inflammation; RANKL-RANK; macrophages; osteoclasts; bisphosphonates; PARTICLE-INDUCED OSTEOLYSIS; TOTAL HIP-ARTHROPLASTY; B DECOY OLIGODEOXYNUCLEOTIDE; TITANIUM NANOPARTICLES INFLUENCE; MACROPHAGE POLARIZING CYTOKINES; POLYETHYLENE WEAR DEBRIS; TOTAL KNEE ARTHROPLASTY; MESENCHYMAL STEM-CELLS; BONE-IMPLANT INTERFACE; TOLL-LIKE RECEPTORS;
D O I
10.3390/jcm8122091
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone-implant interface are under the control of the receptor activator of nuclear factor kappa-Beta ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor kappa B (NF-kappa B) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.
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页数:22
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