title: Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement.
abstract: Aseptic loosening and osteolysis are the most frequent late complications of total hip arthroplasty (THA) leading to revision of the prosthesis. This review aims to demonstrate how histopathological studies contribute to our understanding of the mechanisms of aseptic loosening/osteolysis development. Only studies analysing periprosthetic tissues retrieved from failed implants in humans were included. Data from 101 studies (5532 patients with failure of THA implants) published in English or German between 1974 and 2013 were included. "Control" samples were reported in 45 of the 101 studies. The most frequently examined tissues were the bone-implant interface membrane and pseudosynovial tissues. Histopathological studies contribute importantly to determination of key cell populations underlying the biological mechanisms of aseptic loosening and osteolysis. The studies demonstrated the key molecules of the host response at the protein level (chemokines, cytokines, nitric oxide metabolites, metalloproteinases). However, these studies also have important limitations. Tissues harvested at revision surgery reflect specifically end-stage failure and may not adequately reveal the evolution of pathophysiological events that lead to prosthetic loosening and osteolysis. One possible solution is to examine tissues harvested from stable total hip arthroplasties that have been revised at various time periods due to dislocation or periprosthetic fracture in multicenter studies.
authors: Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic. Electronic address: jiri.gallo@volny.cz.
authors: Jiri
authors: J
authors: Gallo
authors: Department of Pathology, University Hospital Ostrava, Czech Republic.
authors: Jana
authors: J
authors: Vaculova
authors: Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors: Stuart B
authors: SB
authors: Goodman
authors: Institute of Clinical Medicine, Department of Medicine, FIN-00029 HUS, Finland; ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland; COXA Hospital for Joint Replacement, Tampere, Finland.
authors: Yrjö T
authors: YT
authors: Konttinen
authors: Department of Dermatology and Allergology, Copenhagen University, Hospital Gentofte, Denmark.
authors: Jacob P
authors: JP
authors: Thyssen
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D003238:Connective Tissue / Q000503:physiopathology*; D006801:Humans; D010014:Osteolysis
keywords: Aseptic loosening; Immunostaining; Osteolysis; Tissue analysis; Total hip