Atkins Gerald J, Haynes David R, Howie Donald W, Findlay David M
Gerald J Atkins, Donald W Howie, David M Findlay, Discipline of Orthopaedics and Trauma, The University of Adelaide, South Australia 5005, Australia.
World J Orthop. 2011 Oct 18;2(10):93-101. doi: 10.5312/wjo.v2.i10.93.
There is convincing evidence that particles produced by the wear of joint prostheses are causal in the peri-prosthetic loss of bone, or osteolysis, which, if it progresses, leads to the phenomenon of aseptic loosening. It is important to fully understand the biology of this bone loss because it threatens prosthesis survival, and loosened implants can result in peri-prosthetic fracture, which is disastrous for the patient and presents a difficult surgical scenario. The focus of this review is the bioactivity of polyethylene (PE) particles, since there is evidence that these are major players in the development and progression of osteolysis around prostheses which use PE as the bearing surface. The review describes the biological consequences of interaction of PE particles with macrophages, osteoclasts and cells of the osteoblast lineage, including osteocytes. It explores the possible cellular mechanisms of action of PE and seeks to use the findings to date to propose potential non-surgical treatments for osteolysis. In particular, a non-surgical approach is likely to be applicable to implants containing newer, highly cross-linked PEs (HXLPEs), for which osteolysis seems to occur with much reduced PE wear compared with conventional PEs. The caveat here is that we know little as yet about the bioactivity of HXLPE particles and addressing this constitutes our next challenge.
有确凿证据表明，关节假体磨损产生的颗粒是假体周围骨质流失（即骨溶解）的病因，若骨溶解进展，会导致无菌性松动现象。充分了解这种骨质流失的生物学机制很重要，因为它会威胁假体的使用寿命，而松动的植入物可能导致假体周围骨折，这对患者来说是灾难性的，并且会带来棘手的手术情况。本综述的重点是聚乙烯（PE）颗粒的生物活性，因为有证据表明，在以PE作为承重表面的假体周围，这些颗粒在骨溶解的发生和发展中起主要作用。该综述描述了PE颗粒与巨噬细胞、破骨细胞和成骨细胞谱系细胞（包括骨细胞）相互作用的生物学后果。它探讨了PE可能的细胞作用机制，并试图利用目前的研究结果提出骨溶解的潜在非手术治疗方法。特别是，非手术方法可能适用于含有新型高度交联PE（HXLPE）的植入物，与传统PE相比，HXLPE植入物发生骨溶解时的PE磨损似乎要少得多。这里需要注意的是，我们目前对HXLPE颗粒的生物活性了解甚少，解决这一问题是我们的下一个挑战。
