Clinical Factors, Disease Parameters, and Molecular Therapies Affecting Osseointegration of Orthopedic Implants

Abstract

Total hip and knee arthroplasty are effective interventions for management of end-stage arthritis. Indeed, about 7 million Americans are currently living with artificial hip and knee joints. The majority of these individuals, however, will outlive their implants and require revision surgeries, mostly due to poor implant osseointegration and aseptic loosening. Revisions are potentially avoidable with better management of patient-related risk factors that affect the osseointegration of orthopedic implants. In this review, we summarize the published clinical literature on the role of demographics, biologic factors, comorbidities, medications and aseptic loosening risk. We focus on several systemic and local factors that are particularly relevant to implant osseointegration. Examples include physiological and molecular processes that are linked to hyperglycemia, oxidative stress, metabolic syndrome and dyslipidemia. We discuss how orthopedic implant osseointegration can be affected by a number of molecular therapies that are antiresorptive or bone anabolic (i.e. calcium, vitamin D, bisphosphonates, calcitonin, strontium, hormone replacement therapy, selective estrogen-receptor modulators).

Current methods of preventing aseptic loosening and improving osseointegration of titanium implants in cementless total hip arthroplasty: a review

“…Moreover, patients with a body mass index greater than 35 kg/m 2 have double the incidence of titanium implant aseptic loosening following a total hip replacement. 50 This is one of the main reasons, along with an increased risk of prosthetic joint infection, for doctors to include weight loss in their preoperative optimization plan.…”

“…Alcohol intake is not associated with an increase in the rate of titanium implant aseptic loosening. 50 The lack of data does not allow a clear conclusion, but experts consider that elective patients should enrol in a smoking cessation programme 6 to 8 weeks before surgery. 57 …”

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls

“…Various factors contribute to higher IPS values, such as bone quality and quantity [11], implant design [12,13], and surgical technique [14,15]. Also, systemic factors, such as age, metabolic diseases (diabetes, osteoporosis), and smoking can negatively influence secondary implant stability [16][17][18].…”

A diet high in fat and fructose adversely affects osseointegration of titanium implants in rats

“…Recent evidence suggests that osseointegration is in fact a result of an immunologically driven foreign body reaction mounted by the body in response to the implant surface and that long‐term maintenance of this interface depends on equilibrium of this local inflammatory response, which attenuates over time (Albrektsson, Chrcanovic, Jacobsson, & Wennerberg, ; T. Albrektsson, Jemt, Molne, Tengvall, & Wennerberg, ). There is now growing evidence that patient‐related risk factors may impact on the maintenance of this interface (Maradit Kremers, Lewallen, van Wijnen, & Lewallen, ).…”

“…Albrektsson, Jemt, Molne, Tengvall, & Wennerberg, 2019). There is now growing evidence that patientrelated risk factors may impact on the maintenance of this interface (Maradit Kremers, Lewallen, van Wijnen, & Lewallen, 2016).…”