Wear particles, periprosthetic osteolysis and the immune system
Open accessAbstract
The immune system modulates many key biological processes in humans. However, the exact role of the immune system in particle-associated periprosthetic osteolysis is controversial. Human tissue retrieval studies, in vivo and in vitro experiments suggest that the immune response to polymer particles is non-specific and macrophage-mediated. Lymphocytes may modulate this response. However direct lymphocyte activation by polymer particle-protein complexes seems unlikely. However, metallic byproducts may complex with serum proteins and lead to a Type IV, lymphocyte-mediated immune reaction. In predisposed individuals, this reaction may rarely lead to persistent painful joint effusions, necessitating debridement and excision of the bearing surfaces of the prosthesis. In these patients, retrieved periprosthetic tissues exhibit histological evidence of perivascular lymphocytic cuffing. These findings are worrisome, given the fact that increasing numbers of metal-on-metal joint implants are being implanted in younger more active individuals worldwide.
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Wear byproducts from total joint replacements include particulate polymeric, ceramic, and metallic debris and metallic ions, which cause pro-inflammatory responses that can persist for the life of the implant.
“The byproducts of wear include particulate polymeric, ceramic and metallic debris (mostly in the nano, submicron, and micron size range) and in the case of metal-on-metal implants, metallic ions [143]. These byproducts are well known to cause pro-inflammatory responses which can persist for the life of the implant [144,145].”
From Macrophage polarization: an opportunity for improved outcomes in biomaterials and regenerative medicine (2012) · cites this paper as [144]
In total joint replacements, chronic inflammation and foreign body reaction to wear debris result in periprosthetic bone resorption (osteolysis), which can lead to chronic synovitis, loosening, and pathologic fracture.
“In the case of TJR, these processes result in periprosthetic bone resorption (osteolysis) which undermines the bony foundation of the implant and can lead to chronic synovitis, loosening and pathologic fracture [144].”
From Macrophage polarization: an opportunity for improved outcomes in biomaterials and regenerative medicine (2012) · cites this paper as [144]
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Brown, B. N., Ratner, B. D., Goodman, S. B., Amar, S., & Badylak, S. F. (2012) · Biomaterials · doi:10.1016/j.biomaterials.2012.02.034 · Cited by 926 · see citing works
Self-citationMonocytes and macrophages in tissue repair: Implications for immunoregenerative biomaterial design
Ogle, M. E., Segar, C. E., Sridhar, S., & Botchwey, E. A. (2016) · Experimental Biology and Medicine · doi:10.1177/1535370216650293 · Cited by 378 · see citing works
- Authors
- Goodman, S. B.
- Affiliations
- Stanford Medicine (US)
- Corresponding author
- Goodman, Stuart B.
- ORCID
- Goodman, Stuart B.
- Venue
- Biomaterials
- Publisher
- Elsevier BV
- Published
- 2007-12
- Volume
- 28
- Issue
- 34
- Pages
- 5044-5048
- ISSN
- 0142-9612 (ISSN-L)
- PMC
- PMC2065897
- OpenAlex
- W1977415286
- Cited by
- 340
- References
- 0
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 11 · 2023: 14 · 2022: 14 · 2021: 13 · 2020: 26 · 2019: 20 · 2018: 25 · 2017: 22 · 2016: 18 · 2015: 27 · 2014: 27 · 2013: 29 · 2012: 19
- FWCI
- 10.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biomaterials (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R21AR053189, NIH R21 AR053189, R01AR055650)
- Topics
- Health Sciences › Medicine › Surgery › Orthopaedic implants and arthroplasty
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Keywords
- periprosthetic osteolysis, wear debris, macrophage inflammation, delayed-type hypersensitivity, metal-on-metal hip arthroplasty, joint effusion
- MeSH terms
- Animals, Bone Nails, Foreign-Body Reaction, Humans, Immune System, Inflammation, Joint Prosthesis, Lymphocytes, Macrophages, Osteolysis, Polymers, Prosthesis Failure, T-Lymphocytes, Internal Fixators, Arthroplasty, Replacement
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