title: Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty.
abstract: BACKGROUND
  Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO).
  
  
  OBJECTIVE
  The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.
  
  
  METHODS
  A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO.
  
  
  RESULTS
  Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles.
  
  
  CONCLUSIONS
  Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.
authors: Sakarya Education and Research Hospital, 54100, Sakarya, Turkey.
authors: Erhan
authors: E
authors: Sukur
authors: Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, 34470, Istanbul, Turkey.
authors: Yunus Emre
authors: YE
authors: Akman
authors: Istanbul Education and Research Hospital, 34100, Istanbul, Turkey.
authors: Yusuf
authors: Y
authors: Ozturkmen
authors: Bezmialem Vakif University Hospital, 34100, Istanbul, Turkey.
authors: Fatih
authors: F
authors: Kucukdurmaz
keywords: Aseptic; Loosening; Osteolysis; Particle disease; Periprosthetic wear debris