HISTOMORPHOMETRIC ANALYSIS OF CONNECTIVE TISSUE REMODELING IN BONE-ARTIFICIAL HIP PROSTHESIS INTERFACE :

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Aseptic loosening and periprosthetic osteolysis are the major problems awaiting solution in artificial hip joint surgery. The clinical investigation focused on periprosthetic bone remodeling to clarify one important key event in the cascade of connective tissue weakening and osteolysis around artificial hip prosthesis. Twelve acetabular bone samples adjacent to granulomatous synovial-like membrane of loose hip prosthesis were retrieved at revision surgery and processed for Villanueva bone staining for morphological observation and bone histomorphometric analysis. Eight well-fixed bony samples were used as control. Although osteoclastic surface and eroded surface by osteoclasts were evident in the periprosthetic bone from loose hip prosthesis (p=0.003 and p0.027), increased osteoid/low-mineralized bone matrix (p<0.001) and osteoid width (p<0.001) were also significant findings in structural analysis. In addition, not only elevated mineral apposition rate (p=0.044), but also increased mineralizing surface (p=0.044) and bone formation rate (p=0.002) in loose periprosthetic bones were demonstrated in dynamic data analysis. These results were confirmed by precise morphological observation by confocal laser scanning microscopy. Active coupling of bone formation and resorption, and increased osteocytes with abundant bone canalicular projections were found in combined with the presence of immature bone matrices (osteoid and low-minelarized bone areas) in periprosthetic bones from loose hip prosthesis. These results indicated that active osteoclastic bone resorption and/or defective bone formation are coupled with monocytes/macrophages-mediated foreign body type granuloma in the synovial-like interface membrane of loose artificial hip prosthesis. Thus, this unique high turnover periprosthetic bone remodeling with bad bone quality is probably due to the result of cellular host response combined with inappropriate cyclic mechanical loading . The fragile periprosthetic bone may contribute to hip prosthesis loosening and implant failure.

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