Particle disease. A comprehensive theory of periprosthetic osteolysis: a review.
Aseptic loosening and osteolysis are considered the main long-term problems of hip arthroplasty. Pathogenesis of periprosthetic osteolysis is multifactorial, and both the biological and mechanical factors seem to play an important role. Bearing surfaces continuously generate excessive amounts of micron and submicron particles provoking an adverse inflammatory response of periprosthetic connective tissues. In general, a key role has been attributed to macrophages. Cytokines, growth factors, PGE2, and enzymes are secreted with activated periprosthetic cells resulting in formation of osteolytic granulomas. The final osteolytic step is taken predominantly by osteoclasts which are getting ready for action mainly by an osteoprotegerin ligand (RANKL) and TNFalpha. Rankl is expressed by activated macrophages, osteoblasts, and lymphocytes. In parallel, a repetitive hydraulic effect of the joint fluid is manifested on the susceptible bone.
Gallo
Jirí
J
Department of Orthopaedic Surgery, Palacký University Faculty of Medicine, 775 15 Olomouc, Czech Republic.
Kamínek
Petr
P
Tichá
Vlastislava
V
Riháková
Petra
P
Ditmar
Rudolf
R
D019644:Arthroplasty, Replacement, Hip; D001842:Bone and Bones / Q000473:pathology; D002352:Carrier Proteins / Q000502:physiology; D005549:Foreign-Body Reaction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008562:Membrane Glycoproteins / Q000502:physiology; D010010:Osteoclasts / Q000502:physiology; D010014:Osteolysis / Q000209:etiology / Q000503:physiopathology*; D011475:Prosthesis Failure; D053245:RANK Ligand; D053246:Receptor Activator of Nuclear Factor-kappa B; D012086:Reoperation; D015398:Signal Transduction; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D053245:RANK Ligand; D053246:Receptor Activator of Nuclear Factor-kappa B; C505686:TNFRSF11A protein, human; C505688:TNFSF11 protein, human; D014409:Tumor Necrosis Factor-alpha