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Lymphocyte response to polymethylmethacrylate in loose total hip prostheses
J Gil-Albarova1, A Laclériga, C Barrios
1Department of Orthopaedic Surgery and Traumatology, Navarra University Clinic, Pamplona, Spain.
The Journal of Bone and Joint Surgery. British Volume
|November 1, 1992
Summary
Polymethylmethacrylate bone cement can trigger immune responses in patients with loose hip implants. Increased lymphocyte activation, particularly CD25 cells, was observed in patients with positive skin tests, indicating an immune reaction to the cement.
Area of Science:
- Immunology
- Orthopedic Surgery
- Biomaterials Science
Background:
- Aseptic loosening is a common complication of cemented total hip arthroplasties.
- Polymethylmethacrylate (PMMA) bone cement is widely used in orthopedic procedures.
- The role of immune responses in PMMA-related complications requires further elucidation.
Purpose of the Study:
- To investigate the lymphocyte-mediated immune response to PMMA bone cement in patients undergoing revision surgery for aseptic loosening.
- To compare immune responses between patients with loose cemented hip arthroplasties and controls.
Main Methods:
- Study included 26 patients with loose cemented total hip arthroplasties and 8 controls.
- Patch testing with PMMA bone cement was performed.
- Lymphoblast transformation assays were used to assess immune cell activity.
- Flow cytometry with monoclonal antibodies (CD markers) quantified specific immune cell populations (T lymphocytes, B lymphocytes, activated cells).
Main Results:
- Patch tests to PMMA bone cement were positive in 13 patients with loosening.
- Patients with positive patch tests showed significantly higher lymphoblast transformation values compared to those with negative tests or controls.
- Elevated levels of total T and B lymphocytes (CD2, CD22) and activated lymphocytes (CD25) were found in patients with loose prostheses.
- Higher numbers of CD25 lymphocytes correlated with positive patch tests.
- Immune activation was independent of granulomatous lesions at the cement-bone interface.
Conclusions:
- A lymphocyte-mediated immune response to PMMA bone cement occurs in patients with aseptic loosening of cemented total hip arthroplasties.
- Specific immune cell activation, particularly CD25+ lymphocytes, is associated with PMMA sensitivity and implant loosening.
- These findings suggest a potential role for immune reactions in the pathogenesis of aseptic loosening of cemented hip arthroplasties.