Bone formation and bone resorption in failed total joint arthroplasties: Histomorphometric analysis with histochemical and immunohistochemical technique

Abstract

To elucidate the reactions of bone around aseptically loosened total joint arthroplasties, 24 interface tissues with adjacent bone were obtained in 17 revision operations (11 hips and six knees). The morphology of the bone surface next to the interface membrane was investigated with histochemical and immunohistochemical techniques and then histomorphometrically analysed. One-third of the total bone surface. 32.69 +/- 5.16% (mean +/- SE) (n = 24), showed positive alkaline phosphatase activity. The bone surface in contact with the cells positive for CD11b (a macrophage marker) amounted to 19.33 +/- 5.16% (n = 24). The proportion of the osteoclastic bone resorption estimated by vitronectin receptor expression was 7.67 +/- 1.82% (n = 21). Tissues retrieved from the sites where radiographic evidence of osteolysis was present (n = 12) had a significantly larger extent of the bone surface in contact with CD11b-positive cells than did the tissues from areas without osteolysis (n = 12, p = 0.0067, Mann-Whitney U test), whereas no significant difference was observed in the extent of osteoclastic bone resorption. These data demonstrate that active bone formation, regarded as a repair process, is the most common feature even in revised cases. They also highlight the role played by macrophages, not as cells producing inflammatory mediators that could activate osteoclasts, but as cells primarily responsible for the bone loss in osteolytic lesions.

Continuous Infusion of UHMWPE Particles Induces Increased Bone Macrophages and Osteolysis

“…We also detected an increased level of bone remodeling and osteolysis locally in the particle-treated femora similar to the processes of bone remodeling in TJA [1,4,45]. Enhanced bone remodeling stimulated by the infusion of UHMWPE particles is in agreement with the report of Kadoya et al [19] who described similar findings in the bone bed of revised hip arthroplasties. We also demonstrated macrophage to osteoclast-like cell differentiation by double immunostaining of specific cell markers, which was also comprehensively studied by Athanasou and colleagues [3,35,40].…”

Do Genetic Susceptibility, Toll-like Receptors, and Pathogen-associated Molecular Patterns Modulate the Effects of Wear?

“…Consistent with that possibility, antibodies that neutralize sclerostin, an inhibitor of wnt signaling, block the negative effect of polyethylene particles on implant fixation in rats by increasing bone formation and decreasing bone resorption [60]. Also consistent with that possibility, the number of osteoblasts is reduced on bone surfaces surrounding loose implants [49]; patients with high rates of bone formation have lower rates of aseptic loosening [55]; wear particles can reduce osteogenesis in vitro and in animal models [17,108]; and osteoblasts rapidly repair osteolysis induced by wear particles in young mice [48]. Another possibility is that altered wnt signaling results in skeletal anatomy that predisposes the patient to loosening.…”

Cellular profile and cytokine production at prosthetic interfaces

“…Thus, in the prosthetic bony bed, both pro-and anti-inflammatory substances are secreted, which, in turn, modulate bone resorption and formation. These events are closely coupled and, in a recent study, 42 active bone formation was the predominant histological feature in bone and periprosthetic tissues retrieved from both loose and well-fixed implants. In these studies, osteoclasts as well as macrophages appeared to have been directly resorbing bone.…”