A review of UHMWPE wear-induced osteolysis: the role for early detection of the immune response

Abstract

In a world where increasing joint arthroplasties are being performed on increasingly younger patients, osteolysis as the leading cause of failure after total joint arthroplasty (TJA) has gained considerable attention. Ultra-high molecular weight polyethylene wear-induced osteolysis is the process by which prosthetic debris mechanically released from the surface of prosthetic joints induces an immune response that favors bone catabolism, resulting in loosening of prostheses with eventual failure or fracture. The immune response initiated is innate in that it is nonspecific and self-propagating, with monocytic cells and osteoclasts being the main effectors. To date, detecting disease early enough to implement effective intervention without unwanted systemic side effects has been a major barrier. These barriers can be overcome using newer in vivo imaging techniques and modules linked with fluorescence and/or chemotherapies. We discuss the pathogenesis of osteolysis, and provide discussion of the challenges with imaging and therapeutics. We describe a positron emission tomography imaging cinnamoyl-Phe-(D)-Leu-Phe-(D)-Leu-Phe-Lys module, specific to macrophages, which holds promise in early detection of disease and localization of treatment. Further research and increased collaboration among therapeutic and three-dimensional imaging researchers are essential in realizing a solution to clinical osteolysis in TJA.

Joint replacement: Imaging and early intervention may help manage complications

New imaging techniques could help people who undergo joint surgery avoid “wear debris” that can destroy the bone. In a review article, Quanjun Cui and colleagues from the University of Virginia, Charlottesville, USA, describe how the plastic from prosthetic joints can sometimes break down and accumulate in surrounding tissues. There, the material causes local inflammation that degrades the bone and loosens the prosthesis. The researchers discuss an innovative imaging method for detecting immune molecules that could help doctors detect early signs of bone damage, allowing them to select therapies that target the unwanted inflammation without serious side effects. The authors advocate this kind of imaging to manage complications arising from joint replacement operations, a problem that is likely to become more common with increasing numbers of joint surgeries being performed on younger patients.

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