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Instructional Course Lecture   |    
Complications After Total Knee ArthroplastyHow to Manage Patients with Osteolysis
Giles R. Scuderi, MD
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Disclosure: The author did not receive payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. He, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. The author has not had any other relationships, or engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
Look for this and other related articles in Instructional Course Lectures, Volume 61, which will be published by the American Academy of Orthopaedic Surgeons in February 2012:
“Complications After Total Knee Arthroplasty: Evaluation and Management of Complications of the Extensor Mechanism,” by Michael E. Berend, MD
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in February 2012 in Instructional Course Lectures, Volume 61. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Nov 16;93(22):2127-2135. doi: 10.2106/JBJS.9322icl
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Extract

Total knee arthroplasty is one of the most successful orthopaedic procedures. It improves quality of life and has high patient satisfaction and excellent longevity, with survivorship of >90% at fifteen to twenty years. However, mechanical failure remains a complication. Debris particles, especially from polyethylene, affect the long-term durability of the implants1-3. Polyethylene debris incites a chemical and cellular inflammatory reaction, resulting in bone resorption and osteolysis. The extent of the osteolysis is dependent on the volume, size, and shape of the polyethylene debris. The main causative factor leading to osteolysis is small particulate debris, which stimulates an inflammatory foreign-body cellular response, resulting in bone resorption4. In contrast, the large polyethylene particles associated with delamination of the polyethylene and fatigue wear do not elicit the same cellular response2,3.
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