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: 2.77). 06/1996; 326(326):63-70. DOI: 10.1097/00003086-199605000-00008
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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- "Autograft harvest has associated significant donor site morbidity and restrictions on the amount of graft material available, particularly if the patient is elderly and bone stock is deteriorating. Allograft also has limited stocks (Galea et al., 1998), a clinical failure rate of 20–30% and concerns about immunogenicity (Louisia et al., 1999; Summers and Eisenstein, 1989; Wooley et al., 1996). Furthermore, it is likely that with increasing concerns over transmissible spongiform encephalopathies the use of allograft material will be more tightly regulated and restricted in the near future. "
ABSTRACT: Current strategies for bone repair have accepted limitations and the search for synthetic graft materials or for scaffolds that will support ex vivo bone tissue engineering continues. Biomimetic strategies have led to the investigation of naturally occurring porous structures as templates for bone growth. The marine environment is rich in mineralizing organisms with porous structures, some of which are currently being used as bone graft materials and others that are in early stages of development. This review describes the current evidence available for these organisms, considers the relative promise of each and suggests potential future directions.
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- "Previous studies, including ours, indicate that peripheral monocytes from AL patients are activated and exhibit aggressive response to implant wear    . 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 . 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) . "
ABSTRACT: There is currently no cure for aseptic loosening (AL) of total joint replacement (TJR) except surgical revision. The purpose of this study was to determine whether oral EM could improve the periprosthetic tissue profiles and reduce serum cytokine production in AL patients who are candidates for surgical revision. We recruited 32 AL patients. AL patients were treated with either EM (600 mg/day, n=18) or placebo (n=14) daily, started one month before surgery and ending on the day of surgery. Blood samples were obtained before EM treatment and during surgery. Periprosthetic tissues and joint fluids were collected during surgery. Our results demonstrate that oral EM reduces the inflammation of periprosthetic tissues, as manifested by the reduction of the numbers of infiltrating cells, CD68+ macrophages, RANKL+ cells, and TRAP+ cells. Remarkable decreases of TNFalpha (9.6-fold), IL-1beta (21.2-fold), and RANKL (76-fold) gene transcripts were observed in periprosthetic tissues of patients treated with oral EM. Serum levels of both TNFalpha and (to a lesser extent) IL-1beta were significantly reduced following EM treatment (p<0.05). Our results suggest that EM represents a biological cure or prevention for those patients who might need repeated revision surgeries and/or show the early signs of progressive osteolysis after TJR.
- "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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