How prevalent are implant wear and osteolysis, and how has the scope of osteolysis changed since 2000?

Marshall, Amanda; Ries,; Paprosky, Wayne G.

doi:10.5435/00124635-200800001-00003

Cited by 66 publications

(45 citation statements)

References 22 publications

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“…An interesting variation on this model is reflected in the recent demonstration that TLR2 is activated by alkane polymers released into peri-prosthetic tissue by particles of ultra high molecular weight polyethylene, whereas the ultra high molecular weight polyethylene particles themselves disrupt phagosomal membranes and thereby activate inflammasome processing (21,63). Because ultra high molecular weight polyethylene particles are the predominant type of particles in most aseptic loosening patients (64), the released alkane polymers may act together with bacterially derived PAMPs to activate TLRs in these patients.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Pathogen-associated Molecular Patterns Stimulate Biological Activity of Orthopaedic Wear Particles by Activating Cognate Toll-like Receptors

Greenfield

Beidelschies

Tatro

et al. 2010

Journal of Biological Chemistry

117

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Aseptic loosening of orthopaedic implants is induced by wear particles generated from the polymeric and metallic components of the implants. Substantial evidence suggests that activation of Toll-like receptors (TLRs) may contribute to the biological activity of the wear particles. Although pathogen-associated molecular patterns (PAMPs) produced by Gram-positive bacteria are likely to be more common in patients with aseptic loosening, prior studies have focused on LPS, a TLR4-specific PAMP produced by Gram-negative bacteria. Here we show that both TLR2 and TLR4 contribute to the biological activity of titanium particles with adherent bacterial debris. In addition, lipoteichoic acid, a PAMP produced by Gram-positive bacteria that activates TLR2, can, like LPS, adhere to the particles and increase their biological activity, and the increased biological activity requires the presence of the cognate TLR. Moreover, three lines of evidence support the conclusion that TLR activation requires bacterially derived PAMPs and that endogenously produced alarmins are not sufficient. First, neither TLR2 nor TLR4 contribute to the activity of "endotoxin-free" particles as would be expected if alarmins are sufficient to activate the TLRs. Second, noncognate TLRs do not contribute to the activity of particles with adherent LPS or lipoteichoic acid as would be expected if alarmins are sufficient to activate the TLRs. Third, polymyxin B, which inactivates LPS, blocks the activity of particles with adherent LPS. These results support the hypothesis that PAMPs produced by low levels of bacterial colonization may contribute to aseptic loosening of orthopaedic implants.Osteoimmunology is a newly emerging field that refers to bi-directional interactions between the skeletal system and the immune system (1). One example of regulation of the skeletal system by the immune system is inflammatory osteolysis, which is the local bone loss induced by inflammation in response to pathogens or nonpathogenic stimuli (1). Inflammatory osteolysis in response to either pathogens or nonpathogenic stimuli can contribute to loosening of orthopaedic implants and the resultant need to replace the implant. For example, implant infection is a devastating complication that often necessitates implant removal and long term intravenous treatment with antibiotics (2). In contrast, "aseptic loosening" results from inflammation induced by polymeric and metallic wear particles derived from the implant components in the absence of any clinical signs of infection (3, 4). The primary events involved in this process include: phagocytosis of the wear particles by macrophages; activation of the macrophages to produce pro-inflammatory cytokines; stimulation of bone resorptive cytokines, such as RANKL, in response to the proinflammatory cytokines; stimulation of osteoclast differentiation by the resorptive cytokines; and local osteolysis caused by the increased number of osteoclasts (3-5).Subclinical levels of bacteria may contribute to wear particleinduced inflammation, and...

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Section: Discussionmentioning

confidence: 99%

Bacterial Pathogen-associated Molecular Patterns Stimulate Biological Activity of Orthopaedic Wear Particles by Activating Cognate Toll-like Receptors

Greenfield

Beidelschies

Tatro

et al. 2010

Journal of Biological Chemistry

117

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“…We found high functional scores and no differences between the patients with and without these MRI findings. Periprosthetic osteolysis has been described by Marshall et al [32] as ''a silent disease that can progress without symptoms until catastrophic structural failure or mechanical loosening of the implant components occur,'' and this claim has been substantiated in other studies [12,18,21]. If this reactive synovitis does represent early particle disease, it should not be unexpected that we failed to associate its presence to clinical outcomes at this early stage.…”

Section: Discussionmentioning

confidence: 63%

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Cooper

Ranawat

Potter

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis. Questions/purposes We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage. Methods We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12-37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings. Results Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup. Conclusions Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.

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“…For example, early treatment of periacetabular osteolysis allows retention of the acetabular metallic shell with simple exchange of the polyethylene liner (often the particle generator) along with curettage and bone grafting of osteolytic lesions. Delay in recognition precludes retention of the acetabular shell, requiring extensive surgical exposure and augmentation with allograft or metallic fixation to treat bony deficiencies (36).…”

Section: Periprosthetic Osteolysismentioning

confidence: 99%

Magnetic resonance imaging of the postoperative hip

Hayter

Koff

Potter

2012

Magnetic Resonance Imaging

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Magnetic resonance imaging (MRI) is ideally suited to imaging the patient with painful hip arthroplasty due to its superior soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation. MRI is the most accurate imaging modality in the assessment of periprosthetic osteolysis and wear‐induced synovitis, and can also assess regional tendons and neurovascular structures. This article discusses the technical aspects of MRI around metallic implants as well as the appearance of potential complications following hip arthroplasty, including osteolysis, wear‐induced synovitis, infection, hemarthrosis, fracture, loosening, component displacement, heterotopic ossification, tendinopathy, and neurovascular impingement. The specific complication of metal hypersensitivity following metal‐on‐metal prostheses is reviewed. J. Magn. Reson. Imaging 2012;35:1013‐1025. © 2012 Wiley Periodicals, Inc.

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How prevalent are implant wear and osteolysis, and how has the scope of osteolysis changed since 2000?

Cited by 66 publications

References 22 publications

Bacterial Pathogen-associated Molecular Patterns Stimulate Biological Activity of Orthopaedic Wear Particles by Activating Cognate Toll-like Receptors

Bacterial Pathogen-associated Molecular Patterns Stimulate Biological Activity of Orthopaedic Wear Particles by Activating Cognate Toll-like Receptors

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Magnetic resonance imaging of the postoperative hip

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