Mechanically Induced Periprosthetic Osteolysis: A Systematic Review

  • Benjamin A. McArthurEmail author
  • Ryan Scully
  • F. Patrick Ross
  • Mathias P. G. Bostrom
  • Anna Falghren
Review Article



Peri-prosthetic bone loss can result from chemical, biological, and mechanical factors. Mechanical stimulation via fluid pressure and flow at the bone–implant interface may be a significant cause. Evidence supporting mechanically induced osteolysis continues to grow, but there is no synthesis of published clinical and basic science data.


We sought to review the literature on two questions: (1) What published evidence supports the concept of mechanically induced osteolysis? (2) What is the proposed mechanism of mechanically induced osteolysis, and does it differ from that of particle-induced osteolysis?


A systematic review was performed of the PubMed and Web of Science databases. Additional relevant articles were recommended by the senior authors based on their expert opinion. Abstracts were reviewed and the manuscripts pertaining to the study questions were read in full. Studies showing support of mechanically induced osteolysis were quantified and findings summarized.


We identified 49 articles of experimental design supporting the hypothesis that mechanical stimulation of peri-prosthetic bone from fluid pressure and flow can induce osteolysis. While the molecular mechanisms may overlap with those implicated in particle-induced osteolysis, mechanically induced osteolysis appears to be mediated by distinct and parallel pathways.


The role of mechanical stimuli is increasingly recognized in the pathogenesis of peri-prosthetic osteolysis. Current research aims to elucidate the molecular mechanisms to better target therapeutic interventions.


total hip replacement total knee replacement osteolysis revision total joint replacement aseptic loosening 


Compliance with Ethical Standards

Conflict of Interest

Ryan Scully, MD, F. Patrick Ross, PhD, and Anna Falghren, PhD, declare that they have no conflicts of interest. Benjamin A McArthur, MD, reports grants from Orthopedic Research and Education Foundation, during the conduct of the study. Mathias P.G. Bostrom, MD, reports being a paid consultant for Smith & Nephew, outside the submitted work.

Human/Animal Rights


Informed Consent


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Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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Copyright information

© Hospital for Special Surgery 2018

Authors and Affiliations

  • Benjamin A. McArthur
    • 1
    Email author
  • Ryan Scully
    • 2
  • F. Patrick Ross
    • 3
  • Mathias P. G. Bostrom
    • 3
  • Anna Falghren
    • 4
  1. 1.Department of Surgery and Perioperative CareDell Medical School at the University of Texas, Texas Orthopedics Sports and Rehabilitation AssociatesKyleUSA
  2. 2.Department of Orthopedic SurgeryGeorge Washington UniversityWashington, DCUSA
  3. 3.Hospital for Special SurgeryNew YorkUSA
  4. 4.Linköping UniversityLinköpingSweden

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