Mechanisms and modulation of periprosthetic osteolysis

全关节置换术，即完全人工置换自然关节（特别是髋关节和膝关节），是一种通常能减轻疼痛和恢复关节功能的外科手术。2003年，加拿大进行了超过50,000例髋关节和膝关节置换术，其中35%的患者年龄小于65岁。随着预期寿命的增加，需要延长假体的生存期，以避免复杂的翻修手术及其相关的发病率和死亡率。全关节置换术失败的主要原因之一是假体周围骨破坏引起的无菌性松动（假体周围骨溶解）。磨损颗粒的特征取决于植入物类型（金属、聚乙烯、陶瓷），已被证明在很大程度上通过刺激周围细胞诱导假体周围骨溶解，导致炎症介质的释放。因此，更好地理解和调节导致这种不幸的、有时是灾难性的生物反应的机制是很重要的。工程纳米结构（或纳米球）的发展提供了特异性靶向参与骨溶解级联反应的细胞并控制其反应的可能性。

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.