Article

The Immune Response to Implant Materials in Humans

Department of Internal Medicine, Wayne State University, Hutzel Hospital, Detroit, MI 48201, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 06/1996; 326(326):63-70. DOI: 10.1097/00003086-199605000-00008
Source: PubMed

ABSTRACT The etiology of aseptic loosening of prosthetic joint replacement components is unclear. Implant materials have been considered biologically inert, but recently studies indicate that inflammatory reactions directed against the implanted materials may contribute to aseptic loosening. Data suggesting a progression from a simple inflammatory reaction to complex immune responses against the biomaterials are reviewed. The cellular responses to particles of polymethylmethacrylate, ultrahigh molecular weight polyethylene, and alloys of cobalt-chromium and titanium were assayed in vitro to determine cell proliferation in patients with underlying diagnoses of osteoarthrosis, rheumatoid arthritis, and avascular necrosis who had joint replacement. Control populations were provided by patients with similar diagnoses who were preoperative surgical candidates. The underlying diagnoses did not seem to influence responses to particle stimulation. Elevated responses to both acrylic and cobalt-chromium were observed in patients with aseptically loosened prostheses. These findings suggest that the development of a cellular response to particulate debris may be significant in the pathogenesis of aseptic loosening.

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    • "Previous studies, including ours, indicate that peripheral monocytes from AL patients are activated and exhibit aggressive response to implant wear [21] [24] [45] [46]. We have reported that the IL-1β production (mRNA and protein) in patients with stable implants are significantly lower (p b 0.025) than in AL patients [45]. This finding was confirmed by an investigation in a large population of patients who were candidates for either primary TJR (n = 65) or revision surgery (n = 120) [46]. "
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    • "Based mostly on case reports, it has been suggested that hypersensitivity to Ti is associated with implant loosening (Wooley et al 1996; Matthew and Frame 1998), or skin reactions (Peters et al 1984; Yamauchi et al 2000; Tamai et al 2001; High et al 2006; Thomas et al 2006; Watanabe et al 2006). Diagnosis of contact allergy to metals usually relies on combination of anamnestic information and in vivo tests such as a epicutaneous patch test (Hallab et al 2001; Granchi et al 2006), and – in some instances – ex vivo tests such as a Lymphocyte Stimulation Test (LST) on cells from blood samples (Hallab et al 2001). "
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    • "FDG-PET cannot distinguish the aseptically loosened from the infected joint replacement (Love et al., 2004). A significant number of cases of aseptic loosening are the result of an inflammatory/immune reaction (Wooley et al., 1996). Histopathological examinations of failed prostheses show that a synovial-like pseudomembranous structure develops. "
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