Mechanically Induced Periprosthetic Osteolysis: A Systematic Review

Area of Science:

• Biomedical Engineering
• Orthopedic Surgery
• Biomaterials Science

Background:

• Peri-prosthetic bone loss is a significant complication following orthopedic implant surgery.
• Both chemical and biological factors contribute to osteolysis, but mechanical forces are increasingly implicated.
• Fluid pressure and flow at the bone-implant interface represent a key mechanical stimulus.

Purpose of the Study:

• To systematically review the evidence supporting mechanically induced osteolysis.
• To investigate the proposed molecular mechanisms of mechanically induced osteolysis.
• To compare these mechanisms with those of particle-induced osteolysis.

Main Methods:

• Systematic literature review of PubMed and Web of Science databases.
• Inclusion of expert-recommended articles.
• Quantification and summarization of findings from 49 experimental studies.

Main Results:

• 49 studies support the hypothesis that mechanical stimulation induces peri-prosthetic osteolysis.
• Mechanically induced osteolysis is driven by fluid pressure and flow.
• Distinct molecular pathways mediate mechanical osteolysis, though some overlap with particle-induced osteolysis exists.

Conclusions:

• Mechanical stimuli play a recognized role in peri-prosthetic osteolysis pathogenesis.
• Understanding these molecular mechanisms is crucial for developing targeted therapies.
• Further research is needed to fully elucidate these pathways.