Abstract
Background: The rate of revision for some designs of total hip replacements due to idiopathic aseptic loosening has been reported as higher for women. However, whether this is environmental or inherently sex-related is not clear.Objective:Can particle induced osteolysis be sex dependent? And if so, is this dependent on the type of implant debris (e.g. metal vs polymer)? The objective of this study was to test for material dependent inflammatory osteolysis that may be linked to sex using CoCrMo and implant grade conventional polyethylene (UHMWPE), using an in vivo murine calvaria model.Methods:Healthy 12 week old female and male C57BL/6J mice were treated with UHMWPE (1.0um ECD) or CoCrMo particles (0.9um ECD) or received sham surgery. Bone resorption was assessed by micro-computed tomography, histology and histomorphometry on day 12 post challenge.Results:Female mice that received CoCrMo particles showed significantly more inflammatory osteolysis and bone destruction compared to the females who received UHMWPE implant debris. Moreover, females challenged with CoCrMo particles exhibited 120% more inflammatory bone loss compared to males (p<0.01) challenged with CoCrMo implant debris (but this was not the case for UHMWPE particles).Conclusion:We demonstrated sex-specific differences in the amount of osteolysis resulting from CoCrMo particle challenge. This suggests osteo-immune responses to metal debris are preferentially higher in female compared to male mice, and supports the contention that there may be inherent sex related susceptibility to some types of implant debris.
Highlights
Female mice that received CoCrMo particles showed significantly more inflammatory osteolysis and bone destruction compared to the females who received UHMWPE implant debris
Females challenged with CoCrMo particles exhibited 120% more inflammatory bone loss compared to males (p
It is well established that long term implant loosening due to inflammatory bone loss is generally mediated by a subtle innate immune response to accumulating implant debris For some types of total hip replacement designs, there has been a reported difference in the prevalence of aseptic biologic reactivity related implant failure beteween men and women, which ranges from 30% to 100% higher in women than in men [1 - 7] at early time points (3-10 years)
Summary
It is well established that long term implant loosening due to inflammatory bone loss (aseptic inflammatory osteolysis) is generally mediated by a subtle innate immune response to accumulating implant debris For some types of total hip replacement designs (e.g. metal on metal articulating total hip arthroplasty), there has been a reported difference in the prevalence of aseptic biologic reactivity related implant failure beteween men and women, which ranges from 30% to 100% higher in women than in men [1 - 7] at early time points (3-10 years). Reports from national registry data demonstrate that sex and small diameter implants are both independent predictors for implant survival but does not account for obfuscating environmental factors, such as cosmetics exposure, diet, activity level etc [2]. It remains unclear if inherent sex based biologic factors affect implant performance, when it comes to sex dependent effects of specific types of implant debris, such as CoCrMo implant debris from some designs of metal-on-metal (MoM) hip arthroplasty [2 - 4]. Whether this is environmental or inherently sex-related is not clear
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