Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, People's Republic of China.
Orthopedic Research Institute of Zhejiang University, No. 88 Jiefang Road, Hangzhou, People's Republic of China.
J Orthop Res. 2019 Jul;37(7):1489-1497. doi: 10.1002/jor.24217. Epub 2019 Apr 17.
Particle-induced implant loosening is a major challenge to long-term survival of joint prostheses. Administration of intermittent parathyroid hormone (PTH) has shown potential in the treatment of cases of early-stage periprosthetic osteolysis, while sequential administration of intermittent PTH (iPTH) and bisphosphonates (Bps) has achieved significant effects on treatment of postmenopausal osteoporosis. The objective of this study was to determine whether sequential treatment could preserve bone mass and implant fixation during a pathological course of peri-implant osteolysis in a rat model. Ninety male Sprague Dawley rats were randomly divided into nine groups, four of which were used for confirmation of establishment of the peri-implant osteolysis model at two time points, while the other five were used to determine the efficiency of the sequential treatment on peri-implant osteolysis. Implant fixation and peri-implant bone mass were evaluated using biomechanical testing, micro-CT analysis, and histology at 6 and 12 weeks postoperative. The biomechanical test demonstrated that the maximum loading force during a push-out test was significantly elevated in the sequential treatment group compared to the osteolysis group and iPTH withdrawal group at 12 weeks. Peri-implant bone morphology also indicated a robust increase in bone volume in the sequential treatment group. Sequential administration of iPTH and Bps was effective in preventing experimental peri-implant osteolysis, resulting in improved implant fixation and increased peri-implant bone volume. Clinical significance: The innovative application of sequential treatment in peri-implant osteolysis could be used clinically to improve the prognosis of patients with early-stage periprosthetic osteolysis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1489-1497, 2019.
颗粒诱导的植入物松动是关节假体长期生存的主要挑战。间歇性甲状旁腺激素（PTH）的给药已显示出在治疗早期假体周围骨溶解症方面的潜力，而间歇性 PTH（iPTH）和双膦酸盐（Bps）的序贯给药已在治疗绝经后骨质疏松症方面取得了显著效果。本研究的目的是确定在大鼠模型中假体周围骨溶解的病理过程中，序贯治疗是否可以保留骨量和植入物固定。90 只雄性 Sprague Dawley 大鼠随机分为 9 组，其中 4 组用于在两个时间点确认建立假体周围骨溶解模型，其余 5 组用于确定序贯治疗对假体周围骨溶解的效果。术后 6 周和 12 周，采用生物力学测试、微 CT 分析和组织学评估植入物固定和植入物周围骨量。生物力学测试表明，在推挤试验中，最大负载力在 12 周时在序贯治疗组中明显高于骨溶解组和 iPTH 停药组。植入物周围骨形态学也表明，在序贯治疗组中，骨体积明显增加。iPTH 和 Bps 的序贯给药可有效预防实验性假体周围骨溶解，从而改善植入物固定并增加植入物周围骨量。临床意义：序贯治疗在假体周围骨溶解中的创新应用可在临床上用于改善早期假体周围骨溶解患者的预后。
