Open AccessAre there biological markers of wear?
Author(s) -
Thomas W. Bauer,
Arun S. Shanbhag
Publication year - 2008
Publication title -
journal of the american academy of orthopaedic surgeons
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.343
H-Index - 111
eISSN - 1095-8762
pISSN - 1067-151X
DOI - 10.5435/00124635-200800001-00014
Subject(s) - medicine , rankl , osteoprotegerin , osteolysis , osteoarthritis , population , implant , bioinformatics , pathology , dentistry , surgery , receptor , alternative medicine , environmental health , activator (genetics) , biology
Potential systemic markers of implant wear include products of the wear process (particles and ions) and mediators of the inflammatory reaction that can be induced by wear. Ions from polymers used in arthroplasty are not specific, but high metal ion levels may help identify patients with unexpectedly high wear of metal-on-metal implants. The kinetics of ion production, transport, and excretion are complex, however, so it is currently difficult to interpret the significance of mild elevations in metal ions. Indices of bone turnover (eg, collagen fragments) and mediators involved in the inflammatory reaction to particles (eg, osteoprotegerin, RANKL, interleukins) may be associated with osteolysis, but systemic disorders (eg, osteoarthritis) and the use of medications that influence bone remodeling limit the predictive value of these analytes with respect to the consequences of implant wear. Using genomic and proteomic methods to measure multiple analytes offers promise, but the challenge is to identify markers specifically associated with wear that are not elevated by other conditions that often coexist in this patient population.