Physiopathology and pharmacological protection of periprosthetic bone

Over the years, prosthetic surgery has seen improvements in materials, design, component fixation, and surgical techniques to optimize the bone-prosthesis interface. A prosthetic joint acquires a new normality, but may still develop joint pathology. Today, the pathogenetic mechanisms, clinical manifestations, and medical-surgical treatment of these complications are becoming increasingly well understood. In the last two decades, the concept of continuous implant monitoring has emerged, along with the potential for pharmacological protection if necessary. This begins with preoperative treatment of articular Bone Marrow Lesions (BMLs), followed by therapy addressing the postope-rative decrease in Bone Mineral Density (BMD) due to immediate stress shielding, and continues with constant bone remodeling over the years, ultimately addressing potential prosthetic joint pathologies. Thus, long-term prosthetic implant monitoring involves surveillance of bone metabolism and pharmacological treatment with antiresorptive agents, particularly bisphosphonates, as a prerequisite for implant longevity.