Aseptic and septic prosthetic joint loosening: Impact of biomaterial wear on immune cell function, inflammation, and infection
Aseptic and septic prosthetic joint loosening: Impact of biomaterial wear on immune cell function, inflammation, and infection
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DOI：
10.1016/j.biomaterials.2021.121127
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发表时间：
2021-09-24
期刊：
影响因子：
14
通讯作者：
Stegemann, Jan P.
中科院分区：
文献类型：
--
作者：
Hodges, Nicholas A.;Sussman, Eric M.;Stegemann, Jan P.
全关节置换术的成功使得关节成形术在越来越年轻的患者中的使用持续增长。然而，超过10%的患者由于溶骨性松动导致植入物失效而需要翻修手术。这些失效被分类为无菌性或脓毒性，与植入物组件之间的机械作用产生的颗粒磨损碎屑有关。无菌性松动是由与植入物磨损碎屑接触的常驻免疫细胞激活引起的慢性炎症引起的。相比之下，感染性松动定义为植入部位存在慢性感染。然而，最近的研究结果表明，亚临床生物膜可能会被忽视，当评估植入物失败的原因，导致误诊为无菌性松动。许多导致假体周围关节感染的炎症途径也参与骨重塑和骨吸收。特别是，磨损碎屑越来越多地参与抑制先天性和适应性免疫应答，以解决感染或防止血源性传播。本文综述了磨损颗粒和感染相关的植入物松动机制之间的相互联系，以及基于生物材料的对抗感染相关骨溶解的策略。
The success of total joint replacements has led to consistent growth in the use of arthroplasty in progressively younger patients. However, more than 10 percent of patients require revision surgeries due to implant failure caused by osteolytic loosening. These failures are classified as either aseptic or septic and are associated with the presence of particulate wear debris generated by mechanical action between implant components. Aseptic loosening results from chronic inflammation caused by activation of resident immune cells in contact with implant wear debris. In contrast, septic loosening is defined by the presence of chronic infection at the implant site. However, recent findings suggest that subclinical biofilms may be overlooked when evaluating the cause of implant failure, leading to a misdiagnosis of aseptic loosening. Many of the inflammatory pathways contributing to periprosthetic joint infections are also involved in bone remodeling and resorption. In particular, wear debris is increasingly implicated in the inhibition of the innate and adaptive immune response to resolve an infection or prevent hematogenous spread. This review examines the interconnectivity of wear particle-and infection associated mechanisms of implant loosening, as well as biomaterials-based strategies to combat infection related osteolysis.