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Tracing the life cycle of a manmade disease

A remarkable story of how a new disease was inadvertently caused by successful medical treatment, ultimately understood, and eventually defeated by scientific innovation is being told a major player in the process. In the December issue of Clinical Orthopedics and Related Research, William Harris, MD, DSc, of Massachusetts General Hospital (MGH), describes how the development of total hip replacement led to an unexpected problem, erosion of bone adjacent to the implant, and how his team and others both identified the process underlying that breakdown and helped to develop new materials that avoid the problem.

"The history of the unraveling and prevention of this worldwide, unique, severe disease is a fascinating story of the integration of surgical innovation, molecular biology and material science," writes Harris, who is Alan Gerry Clinical Professor of Orthopaedic Surgery at Harvard Medical School.

Harris was a pioneer in the field of joint replacement, beginning in the late 1960s. But he and other surgeons gradually observed that hip implants could loosen starting about 5 years after surgery and eventually fail completely. There were many theories about the cause of that loosening, several which focused on the adhesive used or the possibility of infection.

In 1976 Harris reported that implant failures appeared to be caused by a biological response at the site of the implant, which resulted in erosion of the bone. Looking further into the complication, Harris and colleagues found that, when the metal head of the implant rubbed against the polyethylene joint socket, small particles of polyethylene broke off over time. As the immune system reacted against these foreign particles, eventually it would attack and destroy the bone tissue, loosening the implant to the point of failure. It turned out that this complication was an entirely new manmade disease called periprosthetic osteolysis a condition spawned inadvertently by the medica
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Contact: Sue McGreevey
smcgreevey@partners.org
617-724-2764
Massachusetts General Hospital
21-Dec-2004


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