High-Turnover Periprosthetic Bone Remodeling and Immature Bone Formation Around Loose Cemented Total Hip Joints

Takagi, Michiaki; Santavirta, Seppo; Ida, Hideo; Ishii, Masaji; Takei, Isao; Niissalo, Sirkku; Ogino, Toshihiko; Konttinen, Yrjö T.

doi:10.1359/jbmr.2001.16.1.79

Cited by 58 publications

(56 citation statements)

References 41 publications

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“…However, the same osteolytic response to particulate debris is thought to occur in both pelvic and femoral periprosthetic bone [25]. The histomorphometric changes found by Takagi et al, were also described around both the femoral and pelvic component [31]. Our failure to demonstrate BMD and bio-chcmical marker correlates for these observations may be a result of small sample size.…”

Section: Discussionmentioning

confidence: 59%

“…These cytokincs are also implicated in the pathogenesis of osteoporosis [ l , 13.221, and may mediate diffuse regional bone loss and increased bone turnover as well as the focal osteolytic lesions visible on plain radiographs. Takagi et al [31] recently reported histomorphometric data showing that periprosthetic bone around failed cemented implants has a higher remodelling rate and a decrease in mineralized bone volume compared to that around intact implants. Finally, femoral BMD loss may represent a post-loosening event, as subjects with painful, loose implants typically have lower physical activity levels than those with well functioning implants that may lead to disuse osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

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Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty

Wilkinson

Hamer

Rogers

et al. 2003

Journal Orthopaedic Research

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The aims of this study were to determine whether subjects with aseptic loosening after total hip arthroplasty (THA) have regional differences in periprosthetic bone mineral density (BMD) and systemic biochemical markers of bone turnover compared to subjects with successful implants.Proximal femoral and pelvic BMD were measured by dual energy X-ray absorptiometry and bone turnover markers were assayed in 49 subjects 12.6 f 4.3 (mean f SD) years after cemented THA. Femoral BMD was lower in Gruen zones 2, 5, 6, and 7 in subjects with a loose femoral implant ( n = 17) compared to those ( n = 32) with fixed femoral implants ( P < 0.05 all comparisons). This BMD difference was greatest (-3l'%, P = 0.02) in the proximal and medial region of the femur. Subjects with femoral loosening had higher levels of the bone resorption marker N-telopeptides of type-I collagen ( P = 0.02) than those with a fixed femoral implant. N o diferences in pelvic BMD or bone turnover markers were found between subjects with loose ( n = 18) versus fixed (17 = 31) pelvic implants. This study suggests that failure of femoral components after cemented THA is associated with region-specific decreases in BMD and an increase in urinary excretion of N-telopeptide cross-links of type-I collagen. These surrogate outcome markers may be of value in monitoring response to antiresorptive therapies used to treat periprosthetic osteolysis, although the diagnosis of aseptic loosening remains clinical and radiological.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty

Wilkinson

Hamer

Rogers

et al. 2003

Journal Orthopaedic Research

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show abstract

“…However, no information has so far confirmed these results for human bone as the only information available is based on tissue retrieval obtained from failed implants, the last stage of the degeneration process [31]. Based on a original ex vivo approach, the present study evaluates the micromotion effect on bone resorption for human samples and verifies if resorption could be initiated immediately after surgery, when no wear particles are part of the process.…”

Section: Discussionmentioning

confidence: 79%

Microstimulation at the bone–implant interface upregulates osteoclast activation pathways

Stadelmann¹,

Terrier²,

Pioletti³

2008

Bone

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Peri-implant bone resorption after total joint arthroplasty is a key parameter in aseptic loosening. Implant wear debris and biomechanical aspects have both been demonstrated to be part of the bone resorption process. However, neither of these two parameters has been clearly identified as the primary initiator of peri-implant bone resorption. For the biomechanical parameters, micromotions were measured at the boneimplant interface during normal gait cycles. The amplitude of the micromotions was shown to trigger differentiation of bone tissues. So far no data exists directly quantifying the effect of micromotion and compression on human bone. We hypothesize that micromotion and compression at the bone-implant interface may induce direct activation of bone resorption around the implant through osteoblasts-osteoclasts cell signaling in human bone. This hypothesis was tested with an ex vivo loading system developed to stimulate trabecular bone cores and mimic the micromotions arising at the bone-implant interface. Gene expression of RANKL, OPG, TGFB2, IFNG and CSF-1 was analyzed after no mechanical stimulation (control), exposure to compression or exposure to micromotions. We observed an 8-fold upregulation of RANKL after exposure to micromotions, and downregulation of OPG, IFNG and TGFB2. The RANKL:OPG ratio was upregulated 24-fold after micromotions. This suggests that the micromotions arising at the bone-implant interface during normal gait cycles induce a bone resorption response after only 1 h, which occurs before any wear debris particles enter the system.

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“…Remarkably, one study revealed that cells from the peri‐prosthetic tissue produce several osteoblastic proteins themselves 20. In agreement, histological assessment of peri‐prosthetic tissue demonstrated that this tissue exhibits osteogenic characteristics as shown by the presence of intramembranous formation of osteoid,21, 22 an increased mineral apposition rate and bone formation rate with active osteoblast lining, and production of immature bone matrices with poor bone quality 22. Furthermore, an increased expression of several bone morphogenetic proteins (BMPs) in several cell types of the peri‐prosthetic tissue was found 23.…”

mentioning

confidence: 74%

Peri-prosthetic tissue cells show osteogenic capacity to differentiate into the osteoblastic lineage

et al. 2017

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During the process of aseptic loosening of prostheses, particulate wear debris induces a continuous inflammatory‐like response resulting in the formation of a layer of fibrous peri‐prosthetic tissue at the bone‐prosthesis interface. The current treatment for loosening is revision surgery which is associated with a high‐morbidity rate, especially in old patients. Therefore, less invasive alternatives are necessary. One approach could be to re‐establish osseointegration of the prosthesis by inducing osteoblast differentiation in the peri‐prosthetic tissue. Therefore, the aim of this study was to investigate the capacity of peri‐prosthetic tissue cells to differentiate into the osteoblast lineage. Cells isolated from peri‐prosthetic tissue samples (n = 22)−obtained during revision surgeries−were cultured under normal and several osteogenic culture conditions. Osteogenic differentiation was assessed by measurement of Alkaline Phosphatse (ALP), mineralization of the matrix and expression of several osteogenic genes. Cells cultured in osteogenic medium showed a significant increase in ALP staining (p = 0.024), mineralization of the matrix (p < 0.001) and ALP gene expression (p = 0.014) compared to normal culture medium. Addition of bone morphogenetic proteins (BMPs), a specific GSK3β inhibitor (GIN) or a combination of BMP and GIN to osteogenic medium could not increase ALP staining, mineralization, and ALP gene expression. In one donor, addition of GIN was required to induce mineralization of the matrix. Overall, we observed a high‐inter‐donor variability in response to osteogenic stimuli. In conclusion, peri‐prosthetic tissue cells, cultured under osteogenic conditions, can produce alkaline phosphatase and mineralized matrix, and therefore show characteristics of differentiation into the osteoblastic lineage. © 2016 The Authors. Journal of Orthopaedic Research published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 35:1732–1742, 2017.

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High-Turnover Periprosthetic Bone Remodeling and Immature Bone Formation Around Loose Cemented Total Hip Joints

Cited by 58 publications

References 41 publications

Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty

Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty

Microstimulation at the bone–implant interface upregulates osteoclast activation pathways

Peri-prosthetic tissue cells show osteogenic capacity to differentiate into the osteoblastic lineage

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