BIOMARKERS IN FOCUS: ADDRESSING WEAR AND ASEPTIC LOOSENING IN PATIENTS WITH TOTAL HIP ARTHROPLASTY

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Abstract

Total hip replacement (THR) is a highly successful and impactful procedure for end-stage joint disease, but implant failure remains a major complication. Aseptic loosening, driven by periprosthetic osteolysis, is a primary factor limiting the longevity of THR. Early detection of osteolysis is particularly challenging because patients are often asymptomatic until the condition reaches advanced stages and significant bone loss occur. The consequences of osteolysis are severe and frequently require revision surgery. These procedures are technically complex and carry substantial risks of surgical complications, which can significantly compromise post-operative outcomes.Recent research in THR has focused on improving the tribological properties of prosthetic materials and elucidating the biological mechanisms activated by implant degradation products. Although modern bearings dramatically decreased linear and volumetric wear, new complications have arisen from the use of highly cross-linked polyethylene or ceramics. To date, multibearing systems, metallic friction, corrosion, and controversies surrounding large friction arthroplasties remain matters of concern. A deeper understanding of the local and systemic biological responses to biomaterials could greatly advance our knowledge about the pathogenesis of aseptic loosening. Identifying the molecular and cellular mechanisms involved in this process will not only enable the development of advanced and functionalized biomaterials but also facilitate the early diagnosis of wear particles-induced osteolysis and the development of targeted and personalized therapeutic strategies. Advancements and new perspectives in the integration between large-scale omics and clinical and biomedical research data offer promising opportunities to identify robust biomarkers with greater specificity and sensitivity. Such insights could transform the management of aseptic loosening into a proactive and predictive healthcare approach.In this context, our group has focused on elucidating the cellular and molecular mechanisms underlying aseptic loosening, with a particular interest on identifying specific biomarkers as diagnostic and prognostic tools for tracking disease progression. In this presentation, we will provide an overview of our ongoing research on aseptic loosening biomarkers, emphasizing innovative strategies and addressing the challenges that hinder the successful translation of findings from bench to bedside.