PATHOGENESIS OF BONE LOSS AFTER TOTAL HIP ARTHROPLASTY
Section snippets
Historical Background
Periprosthetic osteolysis was first described around loose cemented femoral components in 1975 by Charnley.12 He noted a “cystic erosion of bone” with an associated macrophage reaction surrounding fractured femoral prostheses. In 1976, Harris et al33 reported on four cases of extensive, localized bone resorption in the femur following THA, observing that the amount and location of the resorption suggested the presence of infection or tumor. In 1977, Willert and Semlitsch99 reported that the
BONE LOSS SECONDARY TO ADAPTIVE BONE REMODELING AND STRESS SHIELDING
Specific design and material features of prostheses can affect the adaptive remodeling patterns. Cemented stems are generally more flexible and create less stress shielding than uncemented stems.40 The critical factor governing bone loss is not just the absolute stem stiffness but its stiffness relative to the femur.40 This relationship depends on the cross-sectional geometry and the material properties of the stem and femur. It is important to note that differences in stiffness between the
AGE-RELATED BONE LOSS
Bone remodeling commences in utero and continues throughout life.26 The bone formation rate is high until around the age of puberty and then declines to levels comparable with those observed in adults. Cancellous bone loss is slow in premenopausal women and results in gradual thinning of trabecular plates. Trabecular plate thinning occurs almost imperceptibly with an average reduction of only about 1 μm (0.6%) per year in trabecular thickness after the age of 35.97 The cellular mechanism
CONCLUSION
Although mechanical factors, the aging process, and adaptive bone remodeling or stress shielding contribute to bone loss after THA, the main mechanisms are thought to be secondary to the biologic reaction to particulate debris. Many cell populations are involved in the histopathology, the most important of which are activated macrophages. In response to the particle challenge, these cells can secrete several proinflammatory mediators, such as cytokines/growth factors, PGE2, and proteolytic
References (102)
Tissue response in relation to type of wear particles around failed hip arthroplasties
J Arthroplasty
(1990)- et al.
A quantitative study of bone and soft tissues in cementless porous coated acetabular components retrieved at autopsy
J Arthroplasty
(1993) - et al.
Autopsy studies of the cement-bone interface in well-fixed cemented total hip replacements
J Arthroplasty
(1993) - et al.
Cellular mediators secreted by interfacial membranes obtained at revision total hip arthroplasties
J Arthroplasty
(1995) - et al.
Decreased trabecular width and increased trabecular spacing contribute to bone loss with aging
Bone
(1987) - et al.
Metallic wear in failed titanium-alloy total hip replacements: A histological and quantative analysis
J Bone Joint Surg Am
(1988) - et al.
Localized endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties
J Bone Joint Surg Br
(1990) - et al.
Comparison of polyethylene wear in machined versus molded polyethylene
Clin Orthop
(1995) - et al.
Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty: A 12-year radiographic review
J Bone Joint Surg Br
(1992) - et al.
The effect of conformity thickness, and material on stresses in ultra-high molecular weight components for total joint replacement
J Bone Joint Surg Am
(1986)
Roentgenographic evaluation of the AML porous-coated acetabular component: A six-year minimum follow-up study
Orthopaedic Transactions
Radiographic assessment of peri-implant femoral bone resorption with a titanium alloy uncemented hip prosthesis
Transactions of the 8th Annual State of the Art
The effect of stem stiffness on femoral bone resorption after canine porous-coated total hip arthroplasty
Clin Orthop
The cellular basis of bone resorption
Clin Orthop
Fractures of femoral prosthesis in total hip replacement: A clinical study
Clin Orthop
Rate of wear in total replacement
Clin Orthop
Wear in total hip replacement
The biomechanical problems of polyethylene as a bearing surface
Clin Orthop
Corrosion between the components of modular femoral hip prostheses
J Bone Joint Surg Br
Radiographic changes in bone demensions in asymptomatic cemented total hip arthroplasties: Result of nine to thirteen-year follow-up
J Bone Joint Surg Am
Histologic, biochemical and ion analysis of tissue and fluids retrieved during total hip arthroplasty
Clin Orthop
Aseptic loosening in uncemented total hip arthroplasty in a canine model
Clin Orthop
Porous-coated hip replacement: The factors governing bone ingrowth, stress shielding, and clinical results
J Bone Joint Surg Br
Porous-coated total hip replacement
Clin Orthop
The biologic effects of implant materials
J Orthop Res
In vivo inflammatory response to polymethylmethacrylate particulate debris: Effect of size, morphology, and surface area
J Orthop Res
Bone resorption activity of particulate-stimulated macrophages
J Bone Miner Res
Normoactive data from iliac crest bone histometry in growing children [abstract]
Bone
Formation of a synovial like membrane at the bone-cement interface: Its role in bone resorption and implant loosening after total hip replacement
Arthritis Rheum
The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis
J Bone Joint Surg Am
A clinical-pathologic-biochemical study of the membrane surrounding loosened and nonloosened total hip arthroplasty
Clin Orthop
The effects of bulk versus particulate polymethylmethacrylate on bone
Clin Orthop
Granulomatous pseudotumors in total joint replacement
Skeletal Radiol
Extensive localized bone resorption in the femur following total hip replacement
J Bone Joint Surg Am
Osteolysis and aseptic loosening in a canine uncemented total hip arthroplasty (THA) model
Transactions of the Orthopaedic Research Society
The differences in toxicity and release of bone resorbing mediators induced by titanium and cobalt-chromium alloy wear particle
J Bone Joint Surg Am
Arthrography after total hip arthroplasty: A modified technique used in the diagnosis of pain
Radiology
Studies of the mechanism by which the mechanical failure of polymethylmethacrylate leads to bone resorption
J Bone Joint Surg Am
Macrophage exposure to polymethylmethacrylate leads to mediator release and injury
J Orthop Res
The various stress patterns of press fit, ingrown and cemented femoral stems
Clin Orthop
Release and excretion of metal in patients who have a total hip replacement component made of titanium-base alloy
J Bone Joint Surg Am
Localized osteolysis in stable non-septic total hip replacement
J Bone Joint Surg Am
Wear of polyethylene acetabular components in total hip arthroplasty
J Bone Joint Surg Am
Histomorphological studies of the long-term skeletal response to well fixed cemented femoral components
J Bone Joint Surg Am
The initiation of failure in cemented femoral components of hip arthroplasties
J Bone Joint Surg Br
Tissue response to particulate polymethylmethacrylate in mice with various immune deficiencies
J Bone Joint Surg Am
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