Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

Abstract

Background:Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO).Objective:The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.Methods:A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO.Results:Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles.Conclusion:Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.

Antiresorptive Agents are More Effective in Preventing Titanium Particle‐Induced Calvarial Osteolysis in Ovariectomized Mice Than Anabolic Agents in Short‐Term Administration

“…As expected, the presence of Ti particles induced profound changes in calvarial bone of both OVX and Sham‐OVX mice, which was consistent with previous studies . Previous research showed that the chronic inflammatory response to wear particles involving macrophages, osteoclasts and osteoblasts plays a pivotal role in the initiation and development of aseptic loosening . Macrophages produce more proinflammatory cytokines (TNF‐α, IL‐6, IL‐1β, and RANKL) after Ti particle stimulation.…”

A numerical and experimental study of RF shimming in the presence of hip prostheses using adaptive SAR at 3 T

“…Hip arthroplasty procedures are a common treatment for advanced osteoarthritis and may result in a number of commonly encountered complications, such as loss of bone tissue and loosening of the implant . Magnetic resonance imaging is one of the preferred diagnostic tools to interrogate the complications, although practical challenges still remain .…”

In vivo analysis of the effects of CoCrMo and Ti particles on inflammatory responses and osteolysis

“…[3][4][5] This complication is a macrophage-based inammatory response to wear particles generated regionally at implant interfaces, and the lifetime of a joint prosthesis has been convincingly shown to depend on the type and amount of implant debris. [6][7][8] The effect of wear particles on periprosthetic osteolysis is mainly associated with the dose, size, shape, and type of wear particle. [9][10][11][12] It is generally recognized that only particles of <10 mm in diameter induce an inammatory response in vitro.…”