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Total joint arthroplasty and the immune response
C A Toumbis1, J L Kronick, P H Wooley
1Wayne State University School of Medicine, Department of Orthopaedic Surgery, Detroit, MI USA.
Seminars in Arthritis and Rheumatism
|August 1, 1997
Summary
Aseptic loosening of prosthetic joints may be caused by immune responses to implant debris. Cellular responses to particles from materials like polymethylmethacrylate and cobalt-chromium are linked to implant failure in joint replacement surgery.
Area of Science:
- Biomaterials Science
- Immunology
- Orthopedic Surgery
Background:
- Total joint replacement arthroplasty is successful for arthritis but aseptic loosening remains a challenge.
- Infection rates are low (<1%) due to improved surgical environments and antibiotics.
- Implant materials, once thought inert, may trigger inflammatory reactions leading to aseptic loosening.
Purpose of the Study:
- To investigate the role of cellular and immune responses to particulate debris in aseptic loosening of total joint replacements.
- To assess the in vitro cellular responses to common implant materials in patients with loosened prostheses.
Main Methods:
- Assayed in vitro cellular responses to particles of polymethylmethacrylate, ultra-high-molecular-weight polyethylene, and cobalt-chromium/titanium alloys.
- Utilized patient samples from osteoarthritis, rheumatoid arthritis, and avascular necrosis cases undergoing total joint replacement.
Main Results:
- Elevated immunologic cell proliferation responses to acrylic and cobalt-chromium particles were observed.
- These responses were particularly noted in patients with aseptically loosened prostheses.
- Data suggest a progression from simple inflammation to complex immune responses against biomaterials.
Conclusions:
- Cellular immune responses to particulate debris from joint replacement materials may significantly contribute to aseptic loosening.
- This highlights the immunologic aspect of biomaterial failure in orthopedic implants.
- Further research into material-specific immune reactions is warranted for improving implant longevity.