Numerous studies provide detailed insight into the triggering and amplification mechanisms of the inflammatory response associated with prosthetic wear particles, promoting final dominance of bone resorption over bone formation in multiple bone multicellular units around an implant. In fact, inflammation is a highly regulated process tightly linked to simultaneous stimulation of tissue protective and regenerative mechanisms in order to prevent collateral damage of periprosthetic tissues. A variety of cytokines, chemokines, hormones and specific cell populations, including macrophages, dendritic and stem cells, attempt to balance tissue architecture and minimize inflammation. Based on this fact, we postulate that the local tissue homeostatic mechanisms more effectively regulate the pro-inflammatory/pro-osteolytic cells/pathways in patients with none/mild periprosthetic osteolysis (PPOL) than in patients with severe PPOL. In this line of thinking, 'particle disease theory' can be understood, at least partially, in terms of the failure of local tissue homeostatic mechanisms. As a result, we envision focusing current research on homeostatic mechanisms in addition to traditional efforts to elucidate details of pro-inflammatory/pro-osteolytic pathways. We believe this approach could open new avenues for research and potential therapeutic strategies.

• MeSH
• Cellular Microenvironment immunology   MeSH
• Hajdu-Cheney Syndrome etiology   immunology   prevention & control   MeSH
• Humans MeSH
• Inflammation Mediators immunology   MeSH
• Arthroplasty, Replacement, Hip * MeSH
• Osteogenesis MeSH
• Joint Prosthesis MeSH
• Prosthesis Failure etiology   MeSH
• Inflammation etiology   prevention & control   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Names of Substances
• Inflammation Mediators MeSH

We analysed data from 155 revisions of identical cementless hip prostheses to determine the influence of patient-, implant- and surgery-related factors on the polyethylene wear rate and size of periprosthetic osteolysis (OL). This was calculated by logistic regression analysis. Factors associated with an increased/decreased wear rate included position of the cup relative to Kohler's line, increase in abduction angle of the cup, traumatic and inflammatory arthritis as a primary diagnosis, and patient height. Severe acetabular bone defects were predicted by an increased wear rate (odds ratio, OR = 5.782 for wear rate above 200 mm(3)/y), and increased height of the patient (OR = 0.905 per each centimetre). Predictors of severe bone defects in the femur were the increased wear rate (OR = 3.479 for wear rate above 200 mm(3)/y) and placement of the cup outside of the true acetabulum (OR = 3.292). Variables related to surgical technique were the most predictive of polyethylene wear rate.

Nous avons analysé les données de 155 révisions d’une prothèse totale de hanche sans ciment de façon à déterminer les facteurs relatifs aux patients et à l’implant concernant l’utilisation du polyéthylène et l’importance de l’ostéolyse (OL). Les 155 modèles de prothèses étaient identiques. Il s’agit d’une analyse informatique. L’augmentation ou la diminution du taux d’usure était associée à la position de la cupule par rapport à la ligne de Kohler, une cupule verticalisée entraînant plus d’usure. De même en ce qui concerne les arthroses d’origine traumatique ou inflammatoire et le poids des patients. On pouvait prévoir d’importantes lésions d’ostéolyse acétabulaire du fait d’une importante augmentation de l’usure du polyéthylène (OR = 5,782 taux d’usure 707, 200 mm3/an) et l’augmentation du poids des patients (OR = 0,905) pour chaque cm. L’augmentation du taux prédictif d’usure avec des lésions osseuses sévères au niveau du fémur l’étaient également (OR = 3,479 d’usure et 200 mm3/an) de même que le positionnement de la cupule en dehors de l’arrière fond acétabulaire (OR = 3,292). Les facteurs d’usure les plus importants sont surtout d’origine technique et secondaires aux problèmes de technique chirurgicale.

• MeSH
• Acetabulum pathology   surgery   MeSH
• Adult MeSH
• Femur Head pathology   surgery   MeSH
• Hip Joint physiopathology   surgery   MeSH
• Hip Prosthesis MeSH
• Middle Aged MeSH
• Humans MeSH
• Logistic Models MeSH
• Stress, Mechanical MeSH
• Arthroplasty, Replacement, Hip adverse effects   MeSH
• Odds Ratio MeSH
• Osteolysis epidemiology   etiology   pathology   MeSH
• Polyethylene MeSH
• Prosthesis Design MeSH
• Reoperation MeSH
• Risk Factors MeSH
• Prosthesis Failure MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Polyethylene MeSH