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The Journal of Bone and Joint Surgery 79:447-52 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

The Role of Access of Joint Fluid to Bone in Periarticular Osteolysis: A Report of Four Cases*

THOMAS P. SCHMALZRIED, M.D.{dagger}, KENNETH H. AKIZUKI, M.D.{ddagger}, ALEXANDER N. FEDENKO, M.D.{dagger} and JOSEPH MIRRA, M.D.{dagger}, LOS ANGELES, CALIFORNIA

Investigation performed at the Joint Replacement Institute at Orthopaedic Hospital, Los Angeles


   Introduction
 
In 1976, Harris et al. reported on four patients who had extensive, localized osteolysis after a total hip replacement14. This erosive or cavitary form of bone resorption has become a major problem that threatens the survival of otherwise successful total hip and knee replacements. Osteolysis has been associated with prosthetic arthroplasties since their introduction. Various etiologies of osteolysis have included infection5 and a foreign-body inflammatory reaction to particulate bone cement25, metal particles32,42, or polyethylene particles37.

While there is substantial evidence that small particles and activated macrophages play an important role in osteolysis, the pathophysiology of this condition has been incompletely defined. The mechanism needs to account for osteolysis that occurs in the absence of a discernible periprosthetic particulate burden32, that develops around femoral endoprostheses inserted without cement27, and that occurs around metal-on-metal total hip replacements38,43. The lesions described in the present report are . . . [Full Text of this Article]


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