Wear particles of total joint replacements and their role in periprosthetic osteolysis

Total joint arthroplasties with metal, plastic, and acrylic materials have revolutionized the surgical treatment of arthritis. Wear of the materials at the articulation and at the sites of attachment to skeleton, however, is a major long-term concern. The particles liberated by fatigue, abrasion, fretting, and corrosion cause foreign body granulomatous reaction in the periprosthetic tissue. This can lead to the activation of cells to produce a variety of cytokines and proteolytic enzymes that can, by complex mechanisms, cause periprosthetic osteolysis and loosening. The mechanisms involved in the production of the wear particles and their biologic consequences are discussed in this report.