Review articleParticle bioreactivity and wear-mediated osteolysis☆
Section snippets
Clinical findings
Wear-mediated osteolysis was first described by Sir John Charnley in 1975 as a “cystic erosion of bone” [12]. While investigating fractured femoral stems, Charnley reported fragments of polymethylmethacrylate (PMMA) bone cement within the surrounding tissue and nonlinear erosion of periprosthetic bone [12]. Later, in 1976, Harris et al [13] reported osteolysis at the proximal femur surrounding loose hip implants and characterized periprosthetic tissue histologically as “sheets of macrophages, a
Particle bioreactivity
Established cell-culture systems have allowed investigators to study the relationship between well-characterized biomaterials and the biological reactions suspected of playing a role in wear-mediated loosening. The complexity of wear-mediated osteolysis can be appreciated by the numerous in vitro studies on particle bioreactivity that have investigated diverse populations of cell types found in the periprosthetic environment, particles differing in size and material composition relevant to the
The current model of wear-mediated osteolysis
The current model of wear-mediated osteolysis hypothesizes that the phagocytosis of wear particles by macrophages and foreign-body giant cells (arising from macrophages) initiates the release of cytokines and other inflammatory mediators, which stimulate increased osteoclastic activity and focal bone resorption at the bone-implant interface. Additionally, osteoblasts and fibroblasts are also believed to play a significant role in aseptic implant loosening, responding to particle exposure with
Anti-inflammatory agents
Ultimately, the goal of wear-particle research is to identify or develop suitable therapeutic agents to treat and eventually reverse or abolish the adverse biological responses to wear particles. Cytokines are generally considered the principal mediators of the initial foreign-body response to orthopedic wear particles. The modulation of proinflammatory cytokines, such as TNF-α, IL-1, and IL-6, may prove useful in ameliorating early aseptic inflammation. As a result, there are an increasing
Conclusion
Until the utopian goal of joint reconstruction via tissue engineering is reached, arthroplasty will continue to be the most efficacious means to restore function of the degenerated joint. Wear-mediated osteolysis, an inherent complication of arthroplasty, is a multidisciplinary problem requiring the coordinated expertise of diverse fields, including orthopedic surgery, cell and molecular biology, clinical pharmacology, and bioengineering, for a solution. Successfully meeting the challenge of
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2022, Journal of Orthopaedic TranslationCitation Excerpt :However, use of the PEEK-on-HXLPE prosthesis is limited by the production of PEEK and PE wear particles, which could activate macrophages and stimulate cells to express pro-inflammatory chemokines, such as interleukin (IL)-1β, IL-6, IL-17, and tumour necrosis factor-α (TNF-α) [10,12,13]. These inflammatory factors can promote the formation and activation of osteoclasts and inhibit osteoblast formation, eventually leading to osteolysis and prosthesis loosening [14–17]. Many researches haven been conducted to reduce wear particle-induced aseptic loosening of total joint replacements (TJRs).
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No benefits or funds were received in support of this study.