Mechanically Induced Periprosthetic Osteolysis: A Systematic Review

Abstract

Background

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.

Questions/Purposes

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?

Methods

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.

Results

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.

Conclusions

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.

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Change history

  • 17 December 2019

    Figure 2 and its caption were inadvertently omitted from the original article. The figure and caption are given below.

  • 17 December 2019

    Figure 2 and its caption were inadvertently omitted from the original article. The figure and caption are given below.

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Correspondence to Benjamin A. McArthur MD.

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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.

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McArthur, B.A., Scully, R., Patrick Ross, F. et al. Mechanically Induced Periprosthetic Osteolysis: A Systematic Review. HSS Jrnl 15, 286–296 (2019). https://doi.org/10.1007/s11420-018-9641-5

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Keywords

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