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What potential biologic treatments are available for osteolysis?

Dr. Schwarz is Professor, Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY.

*The Implant Wear Symposium 2007 Biologic Work Group included Thomas W. Bauer, MD, PhD, Joan Bechtold, PhD, Mathias Bostrom, MD, Patricia A. Campbell, PhD, Victor Goldberg, MD, Stuart B. Goodman, MD, PhD, Ed M. Greenfield, PhD, Joshua J. Jacobs, MD, Yrjö Konttinen, MD, PhD, Regis O’Keefe, MD, PhD, Francis Young-In Lee, MD, Edward M. Schwarz, PhD, Arun S. Shanbhag, PhD, MBA, Robert Lane Smith, PhD, Rocky S. Tuan, PhD, and J. Mark Wilkinson, PhD, FRCS(Tr&Orth).

Dr. Schwarz or a member of his immediate family has received research or institutional support from the National Institutes of Health, DePuy, and Amgen; has received miscellaneous nonincome support, commercially derived honoraria, or other nonresearch-related funding from Amgen; has stock or stock options in Amgen; and is a consultant to or an employee of Amgen.

The host response to wear debris particles constitutes a major component of periprosthetic osteolysis and aseptic loosening. Thus, biologic interventions represent a logical approach to prevent this complication of total joint replacement. Several major obstacles must be overcome before a therapeutic intervention can emerge, most notably the development of a safe and effective drug, as well as the development of a quantitative outcome measure that can prove efficacy in a relatively small multicenter trial of patients with established osteolysis. Research is needed in several areas, including whether a threshold phenomenon exists for osteolytic progression, whether anabolic agents administered postoperatively can significantly increase osteointegration of the implant and reduce the potential for aseptic loosening, and whether RANKL antagonists can inhibit the progression of periprosthetic osteolysis. Imaging advancements and an osteolysis registry would significantly enhance the potential for a successful clinical trial.