Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management
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Periprosthetic osteolysis is a serious complication of total hip replacement (THR) in the medium to long term. Although often asymptomatic, osteolysis can lead to prosthesis loosening and periprosthetic fracture. These complications cause significant morbidity and require complex revision surgery. Here, we review advances in our understanding of the cell and tissue response to particles produced by wear of the articular and non-articular surfaces of prostheses. We discuss the molecular and cellular regulators of osteoclast formation and bone resorptive activity, a better understanding of which may lead to pharmacological treatments for periprosthetic osteolysis. We describe the development of imaging techniques for the detection and measurement of osteolysis around THR prostheses, which enable improved clinical management of patients, provide a means of evaluating outcomes of non-surgical treatments for periprosthetic osteolysis, and assist in pre-operative planning for revision surgery. Finally, there have been advances in the materials used for bearing surfaces to minimise wear, and we review the literature regarding the performance of these new materials to date.
KeywordsPeriprosthetic Osteolysis Clinical management Barrie Vernon-Roberts
The authors acknowledge the profound influence of Professor Barrie Vernon-Roberts on the elucidation of the cause of periprosthetic osteolysis, and on their own research careers and research directions. His remarkable powers of observation, important mentoring activities and scientific insights, support and encouragement have directly and indirectly benefited us all greatly. We thank Dr. Roumen Stamenkov for his contributions to the work. We acknowledge the support of the Australian National Health and Medical Research Council (NHMRC), the Australian Orthopaedic Association Research Foundation, the Royal Adelaide Hospital, the University of Adelaide and the medical and nursing staff of the Royal Adelaide Hospital.
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