Periprosthetic osteolysis: Mechanisms and potential treatment strategies.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. 16. Clin Orthop Relat Res. 2005 Jan;(430):39-45. doi: 10.1097/01.blo.0000149998.88218.05. Pharmacologic modulation of periprosthetic osteolysis. Goodman SB(1), Trindade M, Ma T, Genovese M, Smith RL. Author information: (1)Department of Orthopaedic Surgery and Division of Immunology and Rheumatology, Stanford University Medical Center, Stanford, CA 94305-5341, USA. goodbone@stanford.edu Wear and periprosthetic osteolysis of total joint replacements continue to be the most important problems in arthroplasty surgery. Despite the introduction of improved technologies including alternative bearing surfaces for TJRs, wear is inevitable because of relative movement at different interfaces and processes such as electrolysis and material degradation. Worn, clinically failing implants need to be followed closely and revised when appropriate. However, early wear and minor osteolysis do not result necessarily in progressive failure of the prosthesis. Indeed such cases may be followed up clinically and radiographically to establish the functional and biologic sequelae of wear and the timeline of these events. This scenario provides an opportunity to modulate the adverse biologic reaction associated with wear particles that includes chronic inflammation, the foreign body response, and periprosthetic bone destruction. Currently, immunological events associated with wear particles are becoming understood more clearly. Strategies to mitigate adverse processes associated with wear debris include local or systemic administration of immune modulators, signaling molecules, anti-inflammatory agents and growth factors, and altering osteoclast function. Ultimately, prevention of accelerated wear and periprosthetic osteolysis will be achieved with improved bearing surfaces and prosthetic designs. DOI: 10.1097/01.blo.0000149998.88218.05