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Figure B
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Figure C
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Figure D
6%
292/4561
Figure E
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110/4561
Figure F
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Figure F shows an example of a macrophage, which is a key mediator in the osteolytic process shown in Figure A. Osteolysis is the end result of a biologic process that begins when the number of wear particles following a joint replacement overwhelms the body's capacity to clear them from circulation. The residual particles are phagocytosed by macrophages, which then release an array of cytokines and other inflammatory mediators that recruit osteoclasts to resorb bone. Gupta et al. review osteolysis following total knee arthroplasty, including etiology, diagnosis, and management. Amongst other things, they highlight the importance of design changes to minimize osteolysis including highly cross-linked polyethylene and alternative bearing materials. Ren et al. performed a study where they implanted a hollow titanium rod into the distal femur and pumped polyethylene particles into the femoral bone marrow cavity. They found that macrophage migration occurs at a systemic (rather than local) level, and that the recruitment of macrophages led to localized osteolysis. Holt et al. review the biology behind aseptic osteolysis. Specifically, they highlight the importance of the RANK-RANKL-OPG pathway as the final common pathway to osteoclastogenesis, and the possibility of eliminating osteolysis by blocking this pathway. AMG-162 is a human immunoglobulin monoclonal antibody with a high affinity for RANKL, and studies are currently being undertaken to determine its safety and efficacy. Figure F shows an example of a macrophage, which may be identified by its irregular shape and phagocytic inclusions. Illustration A shows the pathway by which marcrophages induce osteolysis following a joint replacement surgery. Incorrect Answers: Answer 1: Figure B shows is an eosinophil, which may be seen in Eosinophilic Granulomatosis. It has a bilobed nucleus and granules that stain pink when eosin is used in the staining process. Answer 2: Figure C shows a lymphocyte, with a round nucleus and a narrow rim of cytoplasm. Lymphocytes are seen in ALVAL, an adverse reaction to metal-on-metal hip prostheses. Answer 3: Figure D shows a basophil with a multi-lobed nucleus and blue-stained granules. Answer 4: Figure E shows the characteristic appearance of an erythrocyte.
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