The effects of micromotion and particulate materials on tissue differentiation. Bone chamber studies in rabbits

Motion at the interface between bone and implants for joint replacement may interfere with osseointegration and prosthesis stabilization. Particulate materials may cause foreign body and chronic inflammatory reactions resulting in bone resorption (osteolysis). The micromotion chamber (MC) and the bone harvest chamber (BHC) were implanted in the rabbit tibia, and the effects of micromotion and phagocytosable particulate materials on tissue formation within the chamber were assessed by studying bone ingrowth into a 1-mm pore. Using the MC, one short daily episode of motion (20 cycles/day, 0.5 mm amplitude) for three weeks decreased the amount of bone ingrowth. Using a different pore configuration, the same parameters of motion increased bone ingrowth. Increasing the amplitude of motion (from 0.5 to 0.75 mm), or the number of daily motion periods (from one to two per day) then decreased bone ingrowth. These studies suggest the existence of a window of externally applied strain: a small stimulus may facilitate and a large stimulus may discourage bone formation within the chamber. Cessation of a given set of motion parameters (producing primarily fibrous tissue) for an additional three weeks was accompanied by tissue differentiation into bone. Using the BHC, small, phagocytosable particles of bone cement, high density polyethylene and cobalt chrome alloy, at a concentration of 1.0 x 10(8) particles/mL, caused a foreign body reaction and inhibited the ingrowth of bone. Particles of titanium alloy had no effect on net bone formation. In studies using normal and immunodeficient rats, T lymphocytes were not a prerequisite for macrophages to phagocytose polyethylene particles. In the clinical situation, micromotion and particulate debris may be synergistic in producing prosthetic loosening. If an implant does not undergo osseointegration due to excessive micromotion, the fibrous tissue interface may provide a conduit for the subsequent migration of particles around the implant.