The Biology of Aseptic Osteolysis

Abstract

Total hip arthroplasty is one of the most commonly performed and successful elective orthopaedic procedures. However, numerous failure mechanisms limit the long-term success including aseptic osteolysis, aseptic loosening, infection, and implant instability. Aseptic osteolysis and subsequent implant failure occur because of a chronic inflammatory response to implant-derived wear particles. To reduce particulate debris and their consequences, implants have had numerous design modifications including high-molecular-weight polyethylene sockets and noncemented implants that rely on bone ingrowth for fixation. Surgical techniques have improved cementation with the use of medullary plugs, cement guns, lavage of the canal, pressurization, centralization of the stem, and reduction in cement porosity. Despite these advances, aseptic osteolysis continues to limit implant longevity. Numerous proinflammatory cytokines, such as interleukin-1, interleukin-6, tumor necrosis factor-alpha, and prostaglandin E2, have proosteoclastogenic effects in response to implant-derived wear particles. However, none of these cytokines represents a final common pathway for the process of particle-induced osteoclast differentiation and maturation. Recent work has identified the fundamental role of the RANKL-RANK-NF-kappaB pathway not only in osteoclastogenesis but also in the development and function the immune system. Thus, the immune system and skeletal homeostasis may be linked in the process of osteoclastogenesis and osteolysis.

The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

“…Higher rates of wear are linked to higher angles of cup abduction, which can cause edge loading [56]. Increased wear debris from the bearing surface can lead to osteolysis and aseptic loosening of the joint [6,16,21]. This increased wear can be seen in both hard-on-soft and hard-on-hard bearing surfaces [11,14,25,38].…”

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

“…Considered the ''weakest link'' in TKA, submicron polyethylene wear particles induce a cytokinemediated phenomenon leading to periprosthetic osteolysis accounting for 25% of revision TKA [15,18,19]. Polyethylene wear in modular TKA occurs at the articular surface and backside of the insert.…”

Use of Morphometry to Quantify Osteolysis after Total Hip Arthroplasty

“…Osteolysis is a process of bone destruction in response to particulate wear debris [9,16,18,24]. It may develop silently [1,22], but the associated deterioration of the host bone predisposes the patient to periprosthetic fracture or aseptic loosening and may compromise the success of a revision procedure [19,43].…”