Abstract
Osteolysis adjacent to total hip replacement (THR) prostheses is a major cause of their eventual failure. Periprosthetic osteolysis is associated with the production of bioactive particles, produced by the wear of articulating prosthesis surfaces. Wear particles invade the periprosthetic tissue, inducing inflammation and bone resorption. Previous studies have shown that osteocytes, the most numerous cell type in mineralised bone, can respond to wear particles of multiple orthopaedic material types. Osteocytes play important roles in bone resorption, regulating bone resorption by osteoclasts and directly through osteocytic osteolysis, also known as perilacunar remodelling. In this study, we perform a histological analysis of bone biopsies obtained from cohorts of male and female patients undergoing either primary THR surgery or revision THR surgery for aseptic loosening. The osteocyte lacunae area (Ot.Lac.Ar) and percentage lacunar area/bone area (%Ot.Lac.Ar/B.Ar) were significantly larger overall in revision THR bone than bone from similar sites in primary THR. Analysis by patient gender showed that increased Ot.Lac.Ar, indicative of increased perilacunar remodelling, was restricted to female revision samples. No significant differences in osteoclast parameters were detectable between the cohorts. These findings suggest previously unrecognised gender-specific mechanisms of bone loss in orthopaedic wear particle-induced osteolysis in humans.
Highlights
Osteoarthritis is a common joint disorder that leads to total hip replacement (THR) surgery when non-operative treatments fail
Pre-operative CT scans obtained for all 21 revision THR patients showed evidence of osteolysis
Representative images of bone morphometry of primary THR and revision THR biopsies are shown in Figure 2A–C,D–F, respectively
Summary
Osteoarthritis is a common joint disorder that leads to total hip replacement (THR) surgery when non-operative treatments fail. THR alleviates pain and restores mobility to the joint, failure of the implant can occur, commonly due to loosening [1]. Aseptic osteolytic lesions have been identified as a main cause of loosening in implants [2,3,4,5,6,7]. Osteolytic lesions are visualised as radiolucent areas within the bone architecture, more commonly seen in the cancellous bone above the acetabular component of an implant [8]. The production of bioactive wear particles has been identified as a main cause of osteolysis [10] The lesions become devoid of bone and infiltrated with granulomatous tissue that contains multiple cell types including macrophages, fibroblasts, osteoclasts and inflammatory cells [6,9].
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