Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic.
Department of Pathology, University Hospital Ostrava, Czech Republic.
Acta Biomater. 2014 Jun;10(6):2354-66. doi: 10.1016/j.actbio.2014.02.003. Epub 2014 Feb 10.
Aseptic loosening and osteolysis are the most frequent late complications of total hip arthroplasty (THA) leading to revision of the prosthesis. This review aims to demonstrate how histopathological studies contribute to our understanding of the mechanisms of aseptic loosening/osteolysis development. Only studies analysing periprosthetic tissues retrieved from failed implants in humans were included. Data from 101 studies (5532 patients with failure of THA implants) published in English or German between 1974 and 2013 were included. "Control" samples were reported in 45 of the 101 studies. The most frequently examined tissues were the bone-implant interface membrane and pseudosynovial tissues. Histopathological studies contribute importantly to determination of key cell populations underlying the biological mechanisms of aseptic loosening and osteolysis. The studies demonstrated the key molecules of the host response at the protein level (chemokines, cytokines, nitric oxide metabolites, metalloproteinases). However, these studies also have important limitations. Tissues harvested at revision surgery reflect specifically end-stage failure and may not adequately reveal the evolution of pathophysiological events that lead to prosthetic loosening and osteolysis. One possible solution is to examine tissues harvested from stable total hip arthroplasties that have been revised at various time periods due to dislocation or periprosthetic fracture in multicenter studies.
无菌性松动和骨溶解是全髋关节置换术（THA）后最常见的晚期并发症，导致假体翻修。本综述旨在展示组织病理学研究如何有助于我们理解无菌性松动/骨溶解发展的机制。仅纳入了分析从人类失败植入物中取出的假体周围组织的研究。纳入了 1974 年至 2013 年间以英文或德文发表的 101 项研究（5532 例 THA 植入物失败患者）的数据。在 101 项研究中有 45 项报告了“对照”样本。最常检查的组织是骨-植入物界面膜和假性滑膜组织。组织病理学研究对确定无菌性松动和骨溶解生物学机制的关键细胞群具有重要贡献。这些研究证明了宿主反应的关键分子在蛋白质水平上（趋化因子、细胞因子、一氧化氮代谢物、金属蛋白酶）。然而，这些研究也存在重要的局限性。在翻修手术中采集的组织专门反映了终末期失败，可能无法充分揭示导致假体松动和骨溶解的病理生理事件的演变。一种可能的解决方案是在多中心研究中，检查因脱位或假体周围骨折而在不同时间点翻修的稳定全髋关节置换术中采集的组织。
