Abstract
Where Are We Now?
Biological treatments, defined as any nonsurgical intervention whose primary mechanism of action is reducing the host response to wear and/or corrosion products, have long been postulated as solutions for osteolysis and aseptic loosening of total joint arthroplasties. Despite extensive research on drugs that target the inflammatory, osteoclastic, and osteogenic responses to wear debris, no biological treatment has emerged as an approved therapy. We review the extensive preclinical research and modest clinical research to date, which has led to the central conclusion that the osteoclast is the primary target. We also allude to the significant changes in health care, unabated safety concerns about chronic immunosuppressive/antiinflammatory therapies, industry’s complete lack of interest in developing an intervention for this condition, and the practical issues that have narrowly focused the possibilities for a biologic treatment for wear debris-induced osteolysis.
Where Do We Need to Go?
Based on the conclusions from research, and the economic, regulatory, and practical issues that limit the future directions toward the development of a biologic treatment, there are a few rational approaches that warrant investigation. These largely focus on FDA-approved osteoporosis therapies that target the osteoclast (bisphosphonates and anti-RANK ligand) and recombinant parathyroid hormone (teriparatide) prophylactic treatment to increase osseous integration of the prosthesis to overcome high-risk susceptibility to aseptic loosening. The other roadblock that must be overcome if there is to be an approved biologic therapy to prevent the progression of periprosthetic osteolysis and aseptic loosening is the development of radiological measures that can quantify a significant drug effect in a randomized, placebo-controlled clinical trial. We review the progress of volumetric quantification of osteolysis in animal studies and clinical pilots.
How Do We Get There?
Accepting the aforementioned rigid boundaries, we describe the emergence of repurposing FDA-approved drugs for new indications and public (National Institutes of Health, FDA, Centers for Disease Control and Prevention) and private (universities and drug and device manufactures) partnerships as the future roadmap for clinical translation. In the case of biologic treatments for wear debris-induced osteolysis, this will involve combined federal and industry funding of multicenter clinical trials that will be run by thought leaders at large medical centers.
Similar content being viewed by others
References
Arabmotlagh M, Pilz M, Warzecha J, Rauschmann M. Changes of femoral periprosthetic bone mineral density 6 years after treatment with alendronate following total hip arthroplasty. J Orthop Res. 2009;27:183–188.
Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, Garcia-Hernandez PA, Recknor CP, Einhorn TA, Dalsky GP, Mitlak BH, Fierlinger A, Lakshmanan MC. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2009;25:404–414.
Aspenberg P, Johansson T. Teriparatide improves early callus formation in distal radial fractures. Acta Orthop. 2010;81:234–236.
Barra L, Pope JE, Payne M. Real-world anti-tumor necrosis factor treatment in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: cost-effectiveness based on number needed to treat to improve health assessment questionnaire. J Rheumatol. 2009;36:1421–1428.
Bashutski JD, Eber RM, Kinney JS, Benavides E, Maitra S, Braun TM, Giannobile WV, McCauley LK. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010;363:2396–2405.
Bhandari M, Bajammal S, Guyatt GH, Griffith L, Busse JW, Schunemann H, Einhorn TA. Effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2005;87:293–301.
Boyle WJ, Simonet WS, Lacey DL. Osteoclast differentiation and activation. Nature. 2003;423:337–342.
Bragdon CR, Doherty AM, Jasty M, Rubash H, Harris WH. Effect of oral alendronate on net bone ingrowth into canine cementless total hips. J Arthroplasty. 2005;20:258–263.
Chen D, Guo Y, Mao X, Zhang X. Inhibition of p38 mitogen-activated protein kinase down-regulates the inflammatory osteolysis response to titanium particles in a murine osteolysis model. Inflammation. 2012;35:1798–1806.
Chen D, Zhang X, Guo Y, Shi S, Mao X, Pan X, Cheng T. MMP-9 inhibition suppresses wear debris-induced inflammatory osteolysis through downregulation of RANK/RANKL in a murine osteolysis model. Int J Mol Med. 2012;30:1417–1423.
Darowish M, Rahman R, Li P, Bukata SV, Gelinas J, Huang W, Flick LM, Schwarz EM, O’Keefe RJ. Reduction of particle-induced osteolysis by interleukin-6 involves anti-inflammatory effect and inhibition of early osteoclast precursor differentiation. Bone. 2009;45:661–668.
Daugaard H, Elmengaard B, Andreassen T, Bechtold J, Lamberg A, Soballe K. Parathyroid hormone treatment increases fixation of orthopedic implants with gap healing: a biomechanical and histomorphometric canine study of porous coated titanium alloy implants in cancellous bone. Calcif Tissue Int. 2011;88:294–303.
Dong L, Wang R, Zhu YA, Wang C, Diao H, Zhang C, Zhao J, Zhang J. Antisense oligonucleotide targeting TNF-alpha can suppress Co-Cr-Mo particle-induced osteolysis. J Orthop Res. 2008;26:1114–1120.
Fang Q, Wang H, Zhu S, Zhu Q. N-acetyl-L-cysteine inhibits wear particle-induced prosthesis loosening. J Surg Res. 2011;168:e163–172.
Friedl G, Radl R, Stihsen C, Rehak P, Aigner R, Windhager R. The effect of a single infusion of zoledronic acid on early implant migration in total hip arthroplasty. A randomized, double-blind, controlled trial. J Bone Joint Surg Am. 2009;91:274–281.
Geng DC, Xu YZ, Yang HL, Zhu XS, Zhu GM, Wang XB. Inhibition of titanium particle-induced inflammatory osteolysis through inactivation of cannabinoid receptor 2 by AM630. J Biomed Mater Res A. 2010;95:321–326.
Green JM, Hallab NJ, Liao YS, Narayan V, Schwarz EM, Xie C. Anti-oxidation treatment of ultra high molecular weight polyethylene components to decrease periprosthetic osteolysis: evaluation of osteolytic and osteogenic properties of wear debris particles in a murine calvaria model. Curr Rheumatol Rep. 2013;15:325.
Hansson U, Toksvig-Larsen S, Ryd L, Aspenberg P. Once-weekly oral medication with alendronate does not prevent migration of knee prostheses: a double-blind randomized RSA study. Acta Orthop. 2009;80:41–45.
Kauther MD, Bachmann HS, Neuerburg L, Broecker-Preuss M, Hilken G, Grabellus F, Koehler G, von Knoch M, Wedemeyer C. Calcitonin substitution in calcitonin deficiency reduces particle-induced osteolysis. BMC Musculoskelet Disord. 2011;12:186.
Keystone E. Recent concepts in the inhibition of radiographic progression with biologics. Curr Opin Rheumatol. 2009;21:231–237.
Landgraeber S, Jaeckel S, Loer F, Wedemeyer C, Hilken G, Canbay A, Totsch M, von Knoch M. Pan-caspase inhibition suppresses polyethylene particle-induced osteolysis. Apoptosis. 2009;14:173–181.
Li YF, Li XD, Bao CY, Chen QM, Zhang H, Hu J. Promotion of peri-implant bone healing by systemically administered parathyroid hormone (1–34) and zoledronic acid adsorbed onto the implant surface. Osteoporos Int. 2013;24:1063–1071.
Liu S, Virdi AS, Sena K, Sumner DR. Sclerostin antibody prevents particle-induced implant loosening by stimulating bone formation and inhibiting bone resorption in a rat model. Arthritis Rheum. 2012;64:4012–4020.
Ma T, Ren PG, Larsen DM, Suenaga E, Zilber S, Genovese M, Smith RL, Goodman SB. Efficacy of a p38 mitogen activated protein kinase inhibitor in mitigating an established inflammatory reaction to polyethylene particles in vivo. J Biomed Mater Res A. 2009;89:117–123.
Mao X, Pan X, Cheng T, Zhang X. Therapeutic potential of the proteasome inhibitor Bortezomib on titanium particle-induced inflammation in a murine model. Inflammation. 2011;35:905–912.
Mao X, Pan X, Peng X, Cheng T, Zhang X. Inhibition of titanium particle-induced inflammation by the proteasome inhibitor bortezomib in murine macrophage-like RAW 264.7 cells. Inflammation. 2012;35:1411–1418.
Markel DC, Zhang R, Shi T, Hawkins M, Ren W. Inhibitory effects of erythromycin on wear debris-induced VEGF/Flt-1 gene production and osteolysis. Inflamm Res. 2009;58:413–421.
Mediero A, Frenkel SR, Wilder T, He W, Mazumder A, Cronstein BN. Adenosine A2A receptor activation prevents wear particle-induced osteolysis. Sci Transl Med. 2012;4:135–165.
Nich C, Rao AJ, Valladares RD, Li C, Christman JE, Antonios JK, Yao Z, Zwingenberger S, Petite H, Hamadouche M, Goodman SB. Role of direct estrogen receptor signaling in wear particle-induced osteolysis. Biomaterials. 2013;34:641–650.
Niu S, Cao X, Zhang Y, Zhu Q, Zhu J. The inhibitory effect of alendronate-hydroxyapatite composite coating on wear debris-induced peri-implant high bone turnover. J Surg Res. 2012;179:e107–115.
Padhi D, Allison M, Kivitz AJ, Gutierrez MJ, Stouch B, Wang C, Jang G. Multiple doses of sclerostin antibody romosozumab in healthy men and postmenopausal women with low bone mass: A randomized, double-blind, placebo-controlled study. J Clin Pharmacol. 2013;54:168–178.
Prieto-Alhambra D, Javaid MK, Judge A, Murray D, Carr A, Cooper C, Arden NK. Association between bisphosphonate use and implant survival after primary total arthroplasty of the knee or hip: population based retrospective cohort study. BMJ. 2011;343:d7222.
Purdue PE, Koulouvaris P, Potter HG, Nestor BJ, Sculco TP. The cellular and molecular biology of periprosthetic osteolysis. Clin Orthop Relat Res. 2007;454:251–261.
Qu S, Bai Y, Liu X, Fu R, Duan K, Weng J. Study on in vitro release and cell response to alendronate sodium-loaded ultrahigh molecular weight polyethylene loaded with alendronate sodium wear particles to treat the particles-induced osteolysis. J Biomed Mater Res A. 2012;101:394–403.
Rao AJ, Nich C, Dhulipala LS, Gibon E, Valladares R, Zwingenberger S, Smith RL, Goodman SB. Local effect of IL-4 delivery on polyethylene particle induced osteolysis in the murine calvarium. J Biomed Mater Res A. 2012;101:1926–1934.
Ren W, Zhang R, Hawkins M, Shi T, Markel DC. Efficacy of periprosthetic erythromycin delivery for wear debris-induced inflammation and osteolysis. Inflamm Res. 2010;59:1091–1097.
Roelofs AJ, Thompson K, Gordon S, Rogers MJ. Molecular mechanisms of action of bisphosphonates: current status. Clin Cancer Res. 2006;12:6222s–6230s.
Schwarz EM. What potential biologic treatments are available for osteolysis? J Am Acad Orthop Surg. 2008;16 Suppl 1:S72–75.
Schwarz EM, Campbell D, Totterman S, Boyd A, O’Keefe RJ, Looney RJ. Use of volumetric computerized tomography as a primary outcome measure to evaluate drug efficacy in the prevention of peri-prosthetic osteolysis: a 1-year clinical pilot of etanercept vs. placebo. J Orthop Res. 2003;21:1049–1055.
Scott DF, Woltz JN, Smith RR. Effect of zoledronic acid on reducing femoral bone mineral density loss following total hip arthroplasty: preliminary results of a prospective randomized trial. J Arthroplasty. 2012;28:671–675.
Scott DL, Kingsley GH. Tumor necrosis factor inhibitors for rheumatoid arthritis. N Engl J Med. 2006;355:704–712.
Shin DK, Kim MH, Lee SH, Kim TH, Kim SY. Inhibitory effects of luteolin on titanium particle-induced osteolysis in a mouse model. Acta Biomater. 2012;8:3524–3531.
Singh JA, Wells GA, Christensen R, Tanjong Ghogomu E, Maxwell L, Macdonald JK, Filippini G, Skoetz N, Francis D, Lopes LC, Guyatt GH, Schmitt J, La Mantia L, Weberschock T, Roos JF, Siebert H, Hershan S, Lunn MP, Tugwell P, Buchbinder R. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011;2:CD008794.
Skoldenberg OG, Salemyr MO, Boden HS, Ahl TE, Adolphson PY. The effect of weekly risedronate on periprosthetic bone resorption following total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2011;93:1857–1864.
Talmo CT, Shanbhag AS, Rubash HE. Nonsurgical management of osteolysis: challenges and opportunities. Clin Orthop Relat Res. 2006;453:254–264.
Taylor PC. Anti-cytokines and cytokines in the treatment of rheumatoid arthritis. Curr Pharm Des. 2003;9:1095–1106.
Thillemann TM, Pedersen AB, Mehnert F, Johnsen SP, Soballe K. Postoperative use of bisphosphonates and risk of revision after primary total hip arthroplasty: a nationwide population-based study. Bone. 2010;46:946–951.
Trevisan C, Nava V, Mattavelli M, Parra CG. Bisphosphonate treatment for osteolysis in total hip arthroplasty. A report of four cases. Clin Cases Miner Bone Metab. 2013;10:61–64.
Trevisan C, Ortolani S, Romano P, Isaia G, Agnese L, Dallari D, Grappiolo G, Cherubini R, Massari L, Bianchi G. Decreased periprosthetic bone loss in patients treated with clodronate: a 1-year randomized controlled study. Calcif Tissue Int. 2010;86:436–446.
Tsutsumi R, Hock C, Bechtold CD, Proulx ST, Bukata SV, Ito H, Awad HA, Nakamura T, O’Keefe RJ, Schwarz EM. Differential effects of biologic versus bisphosphonate inhibition of wear debris-induced osteolysis assessed by longitudinal micro-CT. J Orthop Res. 2008;26:1340–1346.
Tuan RS, Lee FY, Konttinen T, Wilkinson JM, Smith RL. What are the local and systemic biologic reactions and mediators to wear debris, and what host factors determine or modulate the biologic response to wear particles? J Am Acad Orthop Surg. 2008;16(Suppl 1):S42–S48.
von Knoch F, Wedemeyer C, Heckelei A, Saxler G, Hilken G, Brankamp J, Sterner T, Landgraeber S, Henschke F, Loer F, von Knoch M. Promotion of bone formation by simvastatin in polyethylene particle-induced osteolysis. Biomaterials. 2005;26:5783–5789.
Wang CJ, Wang JW, Weng LH, Hsu CC, Huang CC, Chen HS. The effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty. J Bone Joint Surg Am. 2003;85:2121–2126.
Wang Y, Wu NN, Hu M, Mou YQ, Li RD, Chen L, He BC, Deng ZL. Inhibitory effect of adenovirus-mediated siRNA-targeting BMPR-IB on UHMWPE-induced bone destruction in the murine air pouch model. Connect Tissue Res. 2012;53:528–534.
Wang Y, Wu NN, Mou YQ, Chen L, Deng ZL. Inhibitory effects of recombinant IL-4 and recombinant IL-13 on UHMWPE-induced bone destruction in the murine air pouch model. J Surg Res. 2012;180:e73–81.
Wilkinson JM, Little DG. Bisphosphonates in orthopedic applications. Bone. 2011;49:95–102.
Yamanaka Y, Clohisy JC, Ito H, Matsuno T, Abu-Amer Y. Blockade of JNK and NFAT pathways attenuates orthopedic particle-stimulated osteoclastogenesis of human osteoclast precursors and murine calvarial osteolysis. J Orthop Res. 2012;31:67–72.
Yu X, Zhao X, Wu T, Zhou Z, Gao Y, Wang X, Zhang CQ. Inhibiting wear particles-induced osteolysis with naringin. Int Orthop. 2012;37:137–143.
Zhang W, Peng X, Cheng T, Zhang X. Vascular endothelial growth factor gene silencing suppresses wear debris-induced inflammation. Int Orthop. 2011;35:1883–1888.
Zhang W, Zhao H, Peng X, Cheng T, Zhang X. Low-dose captopril inhibits wear debris-induced inflammatory osteolysis. J Int Med Res. 2011;39:798–804.
Zhao X, Cai XZ, Shi ZL, Zhu FB, Zhao GS, Yan SG. Low-intensity pulsed ultrasound (LIPUS) may prevent polyethylene induced periprosthetic osteolysis in vivo. Ultrasound Med Biol. 2012;38:238–246.
Zhu FB, Cai XZ, Yan SG, Zhu HX, Li R. The effects of local and systemic alendronate delivery on wear debris-induced osteolysis in vivo. J Orthop Res. 2010;28:893–899.
Acknowledgments
We thank Drs. Timothy Wright and Stuart Goodman and our colleagues who participated in the ABKS CT Brighton Workshop on Wear and Tribocorrosion and provided critical insights that were incorporated into this review.
Author information
Authors and Affiliations
Corresponding author
Additional information
One of the authors (EMS) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD (note less than USD 10,000), from Amgen Inc (Thousand Oaks, CA, USA), and an amount of USD (USD 10,000 to USD 100,000) from Lilly Inc (Indianapolis, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.
This work was performed at Stanford University, Stanford, CA, USA, and University of Rochester, Rochester, NY, USA.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Smith, R.L., Schwarz, E.M. Are Biologic Treatments a Potential Approach to Wear- and Corrosion-related Problems?. Clin Orthop Relat Res 472, 3740–3746 (2014). https://doi.org/10.1007/s11999-014-3765-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-014-3765-9