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Paper35-Histological-biological-effects-granulation-tissue-loosened hip-development-osteolysis-J-Ort

Paper35-Histological-biological-effects-granulation-tissue-loosened hip-development-osteolysis-J-Ort

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J Orthop Sci (2004) 9:478–487 DOI 10.1007/s00776-004-0808-1 Histological analysis and biological effects of granulation tissue around loosened hip prostheses in the development of osteolysis S h i g e r u I t o , T o m k M a t s u m o , H i r o s h E n o m t , and H i r o y u k S h i n d o Department of Orthopedic Surgery, Nagasaki University, School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan particles in the granulomatous tissue around the pros- thesis, suggesting that this is the principal cause of osteolysis. 5,6,18 It has been reported that particulate debris stimulates macrophages to release many chemical mediators such as cytokines, which induce bone resorption. 1,8 However, the detailed mechanisms of osteolysis remain unknown. Not only particulate debris but also mechanical stress contributes to loosening of the prosthesis. 17 These find- ings suggest heterogeneity in the histology of granula- tion tissue around the prosthesis, but an insufficient number of samples have been observed to date. There- fore, we investigated 82 samples from patients with aseptic loosened hip prostheses, and compared the his- tological findings of capsules and granulation tissue around the prostheses. To investigate their biological effects on osteolysis, we cultured tissue from a patient with massive osteolysis. Compared with those on macrophages or osteoclasts, 1,10,15,19,20,29 few studies have focused on the behavior of osteoblasts in osteolysis. 4,12 Therefore, in this study, we also examined the effects of conditioned medium from periprosthetic tissue on osteoblasts in vitro. Materials and methods Eighty-two samples were obtained from 40 patients at revision surgery for aseptic loosening of the hip. In- formed consent was obtained after receiving approval from the local ethics committee. The samples were 23 capsules, 23 granulation tissues from around the stem (femoral), and 36 from around the socket (acetabular). The mean patient age was 67 years at revision. The mean interval between the initial surgery and revision surgery was 14 years. The first appearance of loosening could not be identified in 18 patients, because osteolysis was already present when they visited our hospital. Mechanical instability was determined by subsidence or Abstract Although aseptic loosening of the prosthesis is a long-term complication after total joint replacement, the de- tailed mechanism of osteolysis remains unknown. We exam- ined 82 samples from 40 patients with aseptic loosened hip prostheses histologically, and compared the distribution of particles, macrophages/histiocytes, and foreign body giant cells in the retrieved tissue from capsules and around prosthe- ses. Furthermore, to investigate the mechanism of osteolysis, we cultured tissue from a patient with massive osteolysis and examined the effects of the conditioned medium on osteoblasts in vitro. Numerous multinucleated giant cells and histiocytes were present, and polyethylene particles ranging from medium to large were identified in the polarized light.
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