Abstract
The success of implant performance and arthroplasty is based on several factors, including oxidative stress-induced osteolysis. Oxidative stress is a key factor of the inflammatory response. Implant biomaterials can release wear particles which may elicit adverse reactions in patients, such as local inflammatory response leading to tissue damage, which eventually results in loosening of the implant. Wear debris undergo phagocytosis by macrophages, inducing a low-grade chronic inflammation and reactive oxygen species (ROS) production. In addition, ROS can also be directly produced by prosthetic biomaterial oxidation. Overall, ROS amplify the inflammatory response and stimulate both RANKL-induced osteoclastogenesis and osteoblast apoptosis, resulting in bone resorption, leading to periprosthetic osteolysis. Therefore, a growing understanding of the mechanism of oxidative stress-induced periprosthetic osteolysis and anti-oxidant strategies of implant design as well as the addition of anti-oxidant agents will help to improve implants’ performances and therapeutic approaches.
Highlights
Periprosthetic Osteolysis and Implant FailureTotal joint arthroplasty (TJA) is the only fully effective therapeutic choice for patients suffering from end-stage degenerative arthritis
Aseptic loosening is the clinical endpoint of periprosthetic osteolysis, which describes a progressive resorption of bone caused by a host inflammatory response to particulate wear debris [9–11]
This study suggests that the monitoring of the serum levels of these molecules, in correlation with bone remodeling plasmatic markers, could be a sensitive tool for the early detection of periprosthetic osteolysis [53]
Summary
Total joint arthroplasty (TJA) is the only fully effective therapeutic choice for patients suffering from end-stage degenerative arthritis. The most frequent types of surgery are total hip (THA) and knee arthroplasty (TKA). Survivorship of total hip arthroplasty (THA) has improved, such that 90% of current implants still function optimally at 15 years or more post-operatively [1]. Despite improvements in modern prosthetic design, 5 to 10% of THA prostheses undergo revision within 10 years [2, 3]. Osteolysis after THA has been reduced by the use of highly cross-linked polyethylene implant [4], osteolysis and its consequent aseptic. Revision surgery leads to an increase in-hospital mortality, higher morbidity, and poorer functional outcome versus primary THA [6–8]. Implant materials can release wear particles which may induce adverse reactions in patients, such as local inflammatory response leading to tissue damage, eventually results in loosening of the implant. Implant in ultra-high molecular weight polyethylene (UHMWPE) can undergo oxidation process, further boosting the inflammation, which has been recognized as a potential limiting factor for the longevity of this implants in total joint replacements [12]
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