The Basic Science of Periprosthetic Osteolysis

Total joint replacement has been very successful and cost-effective in restoring function and mobility to millions of patients worldwide since its advent more than thirty years ago. With improvements in prophylaxis against infection, the fatigue strength of the components, and skeletal fixation, wear and its sequelae have become the primary limitation to joint replacement longevity1. Initially termed “cement disease,”2 osteolysis is believed to be a biological response not only to polymethylmethacrylate but also to a variety of particles that may originate at several locations around a joint replacement. These include the articulating surfaces, modular component interfaces, fixation surfaces, and devices used for adjuvant fixation3.