Mechanisms and modulation of periprosthetic osteolysis

点击翻译按钮获取中文摘要

Total joint arthroplasty, i.e., the complete artificial replacement of a natural joint (specifically hip and knee), is a surgical procedure that generally provides relief of pain and restoration of joint function. In 2003, more than 50,000 hip and knee replacements were performed in Canada, and 35% of these procedures were performed in patients less than 65 years old. Along with this increase in life expectancy has come a need to prolong prosthesis survivorship to avoid complex revision surgery and its associated morbidity and mortality. One of the major causes of total joint replacement failure is aseptic loosening due to bone destruction around the prosthesis (periprosthetic osteolysis). Wear particles, which characteristics depend on the implant type (metal, polyethylene, ceramic) have been demonstrated to be largely involved in the induction of periprosthetic osteolysis by stimulating the surrounding cells, leading to the release of inflammatory mediators. It is, therefore, important to better understand and modulate the mechanisms leading to this unfortunate and sometimes disastrous biological response. The development of engineered nanostructures (or nanospheres) offers the possibility to target specifically the cells involved in the osteolysis cascade and control their response.