Pharmacologic modulation of periprosthetic osteolysis
Pharmacologic modulation of periprosthetic osteolysis
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DOI：
10.1097/01.blo.0000149998.88218.05
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发表时间：
2005-01-01
影响因子：
4.2
通讯作者：
Smith, RL
中科院分区：
文献类型：
--
作者：
Goodman, SB;Trindade, M;Smith, RL
全关节置换术中的磨损和假体周围骨溶解仍然是关节置换术中最重要的问题。尽管引入了改进的技术，包括替代TJR的轴承表面，但由于不同界面的相对运动和电解和材料降解等过程，磨损是不可避免的。磨损的、临床失效的植入物需要密切随访，并在适当时进行翻修。然而，早期磨损和轻微的骨质溶解并不一定会导致假体的渐进性失效。实际上，此类病例可通过临床和影像学随访，以确定磨损的功能和生物学后遗症以及这些事件的时间轴。这种情况提供了调节与磨损颗粒相关的不良生物反应的机会，包括慢性炎症、异物反应和假体周围骨破坏。目前，与磨损颗粒相关的免疫学事件正变得更加清楚。减轻与磨损碎屑相关的不良过程的策略包括局部或全身施用免疫调节剂、信号分子、抗炎剂和生长因子以及改变破骨细胞功能。最终，通过改进关节面和假体设计，可以防止加速磨损和假体周围骨溶解。
Wear and periprosthetic osteolysis of total joint replacements continue to be the most important problems in arthroplasty surgery. Despite the introduction of improved technologies including alternative bearing surfaces for TJRs, wear is inevitable because of relative movement at different interfaces and processes such as electrolysis and material degradation. Worn, clinically failing implants need to be followed closely and revised when appropriate. However, early wear and minor osteolysis do not result necessarily in progressive failure of the prosthesis. Indeed such cases may be followed up clinically and radiographically to establish the functional and biologic sequelae of wear and the timeline of these events. This scenario provides an opportunity to modulate the adverse biologic reaction associated with wear particles that includes chronic inflammation, the foreign body response, and periprosthetic bone destruction. Currently, immunological events associated with wear particles are becoming understood more clearly. Strategies to mitigate adverse processes associated with wear debris include local or systemic administration of immune modulators, signaling molecules, anti-inflammatory agents and growth factors, and altering osteoclast function. Ultimately, prevention of accelerated wear and periprosthetic osteolysis will be achieved with improved bearing surfaces and prosthetic designs.