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Immunopathological response to loose cementless acetabular components.

S Santavirta1, Y T Konttinen, V Hoikka

  • 1Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland.

The Journal of Bone and Joint Surgery. British Volume
|January 1, 1991
PubMed
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Cementless hip implants can cause adverse tissue reactions due to polyethylene and titanium particles. These particles trigger macrophage responses, indicating that cementless prostheses do not guarantee against such reactions.

Area of Science:

  • Biomaterials Science
  • Orthopedic Surgery
  • Immunology

Background:

  • Loose cementless acetabular implants can elicit tissue responses.
  • Understanding these responses is crucial for improving implant longevity and patient outcomes.

Purpose of the Study:

  • To investigate the histological and cellular responses to particles generated from loose cementless acetabular implants.
  • To determine the role of specific implant materials (titanium alloy, chromium-cobalt-steel) in these reactions.

Main Methods:

  • Analysis of membranes surrounding seven loose cementless acetabular implants.
  • Histological examination using polarized light microscopy to identify polyethylene and metal particles.
  • Immunohistochemical staining for macrophages (CD11b), T cells (interleukin-2 receptor), and plasma cells (PCA-1).

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Main Results:

  • Polyethylene particles were present in all implant membranes.
  • Titanium particles were found around titanium alloy implants but not metallosis.
  • Particles induced macrophage migration, adherence, and phagocytosis without specific immune activation.
  • Fibroblast activity varied with loosening severity, with aggressive cases showing more macrophages and giant cells.

Conclusions:

  • Cementless prostheses do not guarantee against adverse tissue reactions.
  • Both polyethylene and titanium particles can elicit significant macrophage-mediated inflammatory responses.
  • The observed reactions highlight the importance of material wear debris in implant loosening and failure.