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Updated: Aug 8, 2026
Biological Compatibility Profile on Biomaterials for Bone Regeneration
Published on: November 16, 2018
Cellular profile and cytokine production at prosthetic interfaces. Study of tissues retrieved from revised hip and
1Stanford University School of Medicine, California, USA.
Insights
Osteolysis around joint replacements involves different immune cells and cytokines. Cemented implants show increased macrophages and IL-1/IL-6, while cementless implants show more T-lymphocytes and TNF alpha, indicating distinct biological mechanisms.
Area of Science:
- Biomaterials Science
- Immunology
- Orthopedic Surgery
Background:
- Total joint replacements (TJR) can fail due to aseptic loosening and osteolysis.
- Understanding the cellular and molecular mechanisms driving implant failure is crucial for improving TJR outcomes.
- Distinguishing biological responses between cemented and cementless implants is essential.
Purpose of the Study:
- To characterize the cellular and cytokine profiles of periprosthetic tissues in revised cemented and cementless total joint replacements.
- To investigate the relationship between these profiles and the presence/grade of osteolysis and loosening.
- To elucidate potential differences in biological mechanisms underlying failure in cemented versus cementless implants.
Main Methods:
- Immunohistochemistry was used to identify cell types in periprosthetic tissues.
- In situ hybridization was employed to assess cytokine expression (IL-1, IL-6, TNF alpha).
- Tissues from 65 cemented and 36 cementless revised joint replacements were analyzed.
Main Results:
- Three distinct groups were identified: loose with osteolysis, loose without osteolysis, and well-fixed implants.
- In cemented implants, osteolysis correlated with increased macrophages and IL-1/IL-6 expression.
- In cementless implants, osteolysis correlated with increased T-lymphocytes and TNF alpha expression.
Conclusions:
- Distinct biological mechanisms contribute to loosening and osteolysis in cemented and cementless implants.
- T-lymphocyte modulation of macrophage function may play a significant role at the prosthetic interface.
- These findings highlight the need for tailored strategies based on implant type and failure mode.
Abstract:
The tissues surrounding 65 cemented and 36 cementless total joint replacements undergoing revision were characterised for cell types by immunohistochemistry and for cytokine expression by in situ hybridisation. We identified three distinct groups of revised implants: loose implants with ballooning radiological osteolysis, loose implants without osteolysis, and well-fixed implants. In the cemented series, osteolysis was associated with increased numbers of macrophages (p = 0.0006), T-lymphocyte subgroups (p = 0.03) and IL-1 (p = 0.02) and IL-6 (p = 0.0001) expression, and in the cementless series with increased numbers of T-lymphocyte subgroups (p = 0.005) and increased TNF alpha expression (p = 0.04). For cemented implants, the histological, histochemical and cytokine profiles of the interface correlated with the clinical and radiological grade of loosening and osteolysis. Our findings suggest that there are different biological mechanisms of loosening and osteolysis for cemented and cementless implants. T-lymphocyte modulation of macrophage function may be an important interaction at prosthetic interfaces.
