Related Experiment Video
Updated: Mar 17, 2026
Biological Compatibility Profile on Biomaterials for Bone Regeneration
Published on: November 16, 2018
Articulating polymethylmethacrylate (PMMA) spacers may have an immunomodulating effect on synovial tissue
G Singh1, N Deutloff2, N Maertens2
1University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Kent Ridge Road, 119228, Singapore.
Aims:
Tissue responses to debris formed by abrasion of polymethylmethacrylate (PMMA) spacers at two-stage revision arthroplasty for prosthetic joint infection are not well described. We hypothesised that PMMA debris induces immunomodulation in periprosthetic tissues.
Patients And Methods:
Samples of tissue were taken during 35 two-stage revision arthroplasties (nine total hip and 26 total knee arthroplasties) in patients whose mean age was 67 years (44 to 85). Fourier transform infrared microscopy was used to confirm the presence of PMMA particles. Histomorphometry was performed using Sudan Red and Haematoxylin-Eosin staining. CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype the inflammatory cells. All slides were scored semi-quantitatively using the modified Willert scoring system.
Results:
The mean CD-68 scores did not show any significant change during the six weeks between the stages. Perivascular and diffuse scores showed significant difference in CD-3, CD-20, CD-11(c) and IL-17. At the time of re-implantation, a shift in the pattern of the expression of dendritic cells towards a perivascular arrangement and towards the periphery of PMMA particles was observed. Positive microbiological cultures were found at the time of re-implantation in three patients. Five further revisions were required for other reasons.
Conclusion:
Our results represent a biological reaction of the synovial tissues to spacers with a less diffuse expression of dendritic cells and an increased expression of perivascular lymphocytes. The use of spacers in two-stage revision for infection probably induces an immunomodulation of synovial tissues. Cite this article: Bone Joint J 2016;98-B:1062-8.
Insights
Polymethylmethacrylate (PMMA) debris from joint spacers may alter immune responses in tissues during two-stage revision arthroplasty for infection. This study observed changes in immune cell patterns around PMMA particles, suggesting immunomodulation.
Area of Science:
- Orthopedic Surgery
- Immunology
- Biomaterials Science
Background:
- Two-stage revision arthroplasty for prosthetic joint infection often involves polymethylmethacrylate (PMMA) spacers.
- The tissue response to PMMA debris generated by these spacers is not fully understood.
- Understanding this response is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the immunomodulatory effects of PMMA debris on periprosthetic tissues during two-stage revision arthroplasty.
- To characterize the inflammatory cell infiltration and expression patterns in response to PMMA particles.
Main Methods:
- Tissue samples were collected from 35 patients undergoing two-stage revision arthroplasty.
- Fourier transform infrared microscopy confirmed PMMA particle presence.
- Immunohistochemistry (CD-68, CD-20, CD-11(c), CD-3, IL-17) and histomorphometry were used to analyze cellular responses.
Main Results:
- No significant change in mean CD-68 scores was observed between stages.
- Significant differences in CD-3, CD-20, CD-11(c), and IL-17 expression were noted in perivascular and diffuse areas.
- Dendritic cell expression shifted towards a perivascular arrangement and the periphery of PMMA particles.
Conclusions:
- Synovial tissue exhibits a biological reaction to PMMA spacers, characterized by altered dendritic cell distribution and increased perivascular lymphocytes.
- The use of PMMA spacers in two-stage revision for joint infection likely induces immunomodulation of synovial tissues.
- These findings highlight the complex interplay between biomaterial debris and the host immune system in infected joint revisions.
