The correlation of RANK, RANKL and TNFα expression with bone loss volume and polyethylene wear debris around hip implants

Holding, C.A.; Findlay, David M.; Stamenkov, Roumen; Neale, S D; Lucas, Helen; Dharmapatni, Anak; Callary, Stuart A.; Shrestha, Kush R.; Atkins, Gerald J.; Howie, Donald W.; Haynes, David R.

doi:10.1016/j.biomaterials.2006.05.054

Cited by 113 publications

(96 citation statements)

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“…Considered the ''weakest link'' in TKA, submicron polyethylene wear particles induce a cytokinemediated phenomenon leading to periprosthetic osteolysis accounting for 25% of revision TKA [15,18,19]. Polyethylene wear in modular TKA occurs at the articular surface and backside of the insert.…”

Section: Introductionmentioning

confidence: 99%

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

Lombardi

Ellison

Berend

2008

Clinical Orthopaedics &Amp; Related Research

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Polyethylene insert backside surface wear is implicated in osteolysis and failure of total knee arthroplasty. Manufacturing and sterilization methods reduce articular-sided wear. We questioned whether manufacturing technique influences the severity of backside wear. We examined 39 explanted tibial bearings in a blinded fashion using visual, stereomicroscopic, and scanning electron microscopic techniques. We examined 26 direct compression molded components and 13 nondirect compression molded components and applied a new backside wear severity score. The score characterized the magnitude of the various modes of wear with severity ranging from 0 (no wear) to 27 (severe wear). Time in vivo, tibial baseplate material, and manufacturing technique were used as variables for comparison. Backside wear was related to polyethylene manufacturing process with direct compression molded implants having a wear score of 2.3 and nondirect compression molded a score of 5.7. Time in vivo influenced backside wear, although direct compression molded predicted decreased backside wear independent of time in vivo. The data suggest manufacturing technique influences backside wear in total knee arthroplasty polyethylene inserts.

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Section: Introductionmentioning

confidence: 99%

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

Lombardi

Ellison

Berend

2008

Clinical Orthopaedics &Amp; Related Research

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“…First, by confining our review to studies that included quantitative or semiquantitative grading of the histologic findings, we excluded many publications that have used only qualitative descriptions of periarticular findings [5,12,29,35,42,44,46] or that have focused on particle quantitation [13,30,45], cytokine detection [9,21], or lymphocyte subsets [29]. Among the studies that have graded morphologic features of periprosthetic tissues, many have not included conventional metal-on-PE or ceramic-on-polyethylene cases as controls, and differences in grading criteria among studies preclude pooling the data into larger groups.…”

Section: Discussionmentioning

confidence: 99%

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

Bauer

Campbell

Hallerberg

2014

Clin Orthop Relat Res

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Background The biologic reactions to byproducts of wear or corrosion can involve innate and adaptive processes and are dependent on many factors, including the composition, size, surface properties, shape, and concentration of debris. Questions/purposes We used a systematic literature review to compare the reported patterns of inflammation in tissues around total hip implants with the goal of identifying whether there are unique or characteristic patterns associated with the newer bearing options or modular components. Methods A search of the Ovid Medline database between 1996 and early December 2013 identified articles that compared the histology around six implant groups: (1) metal-on-metal; (2) ceramic-on-ceramic; (3) metalon-crosslinked polyethylene; (4) metal-on-conventional polyethylene with or (5) without modularity; and (6) tissue obtained at primary arthroplasty. Our initial search yielded 865 citations. After excluding articles that lacked a quantitative or semiquantitative description of histologic findings in periprosthetic tissue, we reviewed 34 articles. Results No pattern of inflammation is specific for any given bearing combination. Histologic features suggestive of an adaptive immune response appear to be more frequent and of greater magnitude in failed metal-on-metal implants, but tissues around many failed metal-on-metal implants show features of an ''innate'' foreign body reaction without lymphocytes. Occasional nonmetal-on-metal implants show features of an immune reaction, possibly associated with metal particles. Modular connections are one source of metal debris in nonmetal-on-metal implants. Features of an immune reaction appear rare in ceramicon-ceramic implants that lack corrosion. Insufficient reports are available to characterize the biologic response to crosslinked polyethylene.

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“…It is well established that the activated RANKL/RANK ligandreceptor complex is central to the differentiation and activity of osteoclasts, and therefore bone resorption [29][30][31] . The expression and activity of RANKL is known to be induced by a number of proinflammatory cytokines and we and others have shown that TNFα can greatly enhance RANKL activity 28,[32][33][34] .…”

Section: Identification Of Bone Resorbing Mediatorsmentioning

confidence: 91%

“…In addition to these inflammatory mediators, we have shown that an accumulation of wear particles is also frequently associated with a marked increase in expression of receptor activator NF-κB ligand (RANKL) and its receptor, RANK 27,28 . It is well established that the activated RANKL/RANK ligandreceptor complex is central to the differentiation and activity of osteoclasts, and therefore bone resorption [29][30][31] .…”

Section: Identification Of Bone Resorbing Mediatorsmentioning

confidence: 99%

“…Immunohistochemical and in situ hybridisation studies of periprosthetic tissue from sites adjacent to osteolytic lesions have revealed that macrophages, multinucleated giant cells and, to a lesser extent, fibroblasts express high levels of RANK, RANKL and TNFα 26,28,35 . Our studies have found strong correlations between osteolytic lesion size, the concentration of polyethylene particles, and RANK, RANKL and TNFα expression 28 .…”

Section: Identification Of Bone Resorbing Mediatorsmentioning

confidence: 99%

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Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management

et al. 2013

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"Authors may self-archive the author's accepted manuscript of their articles on their own websites. Authors may also deposit this version of the article in any repository, provided it is only made publicly available 12 months after official publication or later. He/ she may not use the publisher's version (the final article), which is posted on SpringerLink and other Springer websites, for the purpose of self-archiving or deposit. Furthermore, the author may only post his/her version provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be provided by inserting the DOI number of the article in the following sentence: "The final publication is available at Springer via http://dx.doi.org/[insert DOI]"." PERIPROSTHETIC OSTEOLYSIS AFTER TOTAL HIP REPLACEMENT: MOLECULAR PATHOLOGY AND CLINICAL MANAGEMENT AbstractPeriprosthetic osteolysis is a serious complication of total hip replacement in the medium to long-term.Although often asymptomatic, osteolysis can lead to prosthesis loosening and periprosthetic fracture.These complications cause significant morbidity and require complex revision surgery. Here, we review advances in our understanding of the cell and tissue response to particles produced by wear of the articular and non-articular surfaces of prostheses. We discuss the molecular and cellular regulators of osteoclast formation and bone resorptive activity, a better understanding of which may lead to pharmacological treatments for periprosthetic osteolysis. We describe the development of imaging techniques for the detection and measurement of osteolysis around total hip replacement prostheses, which enable improved clinical management of patients, provide a means of evaluating outcomes of non-surgical treatments for periprosthetic osteolysis, and assist in pre-operative planning for revision surgery. Finally, there have been advances in the materials used for bearing surfaces to minimise wear, and we review the literature regarding the performance of these new materials to date. 2 The problem of periprosthetic osteolysisLoosening of hip replacement prostheses due to loss of adjacent bone, known as peri-prosthetic osteolysis, is the most common reason for revision of total hip replacements in the medium to longterm 1-3 . Non-linear periprosthetic osteolysis is characterised by localised and often ballooning lesions in bone adjacent to prostheses and is often first noted around stable prostheses before the bone loss leads to loosening 4 . Even when this type of osteolysis is progressive and results in major bone loss, patients may remain asymptomatic until the bone fails to support the prosthetic implant, at which time major revision surgery is required. Fluid pressure and wear particles at the bone prosthesis interface cause osteolysisThe mechanism of periprosthetic osteolysis is likely to be multifactorial. While factors such as prosthesis design, surgical technique and quality of fixation are known to be impo...

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The correlation of RANK, RANKL and TNFα expression with bone loss volume and polyethylene wear debris around hip implants

Cited by 113 publications

References 36 publications

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management

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