Benign Responses to Orthopaedic Implants: Really?

Cooper, H. John; Jacobs, Joshua J.

doi:10.1007/978-1-4614-8999-3_8

Cited by 3 publications

(4 citation statements)

References 131 publications

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“… 10 - 12 MoP articulations generally produce greater volumetric wear than MoM implants, but MoM implants generate a much larger number of particles, the metal particles being an order of magnitude smaller in size and, therefore, much more numerous. 10 - 14 Ultra-high molecular weight polyethylene (UHMWP) particles can vary in size from very large (hundreds of microns) to very small (submicron) with a mean size of 660 nm. Analysis of particles generated from MoM articulations has shown that most cobalt-chrome (Co-Cr) particles are nanometre in size (mean 30 nm to 57 nm).…”

Section: Innate Immune Response To Implant-derived Wearmentioning

confidence: 99%

“…Phagocytosed metal particles are transported to lysosomes where, in the acid microenvironment of these organelles, they are subject to corrosion, resulting in the release of chromium and cobalt ions and consequent apoptosis and cell death. 8 , 9 , 11 , 41 - 43 This process is likely to contribute significantly to the extensive necrosis seen in MoM peri-implant tissues. The physicochemical features of nano-sized metal wear particles, which are of small size and have a large specific surface area that predicts greater biological activity (including cytotoxicity) compared with larger UHMWP particles, is likely to be significant in this regard.…”

Section: Innate Immune Response To Implant-derived Wearmentioning

confidence: 99%

“…It is possible that the measurement of metal ion levels in periprosthetic tissue correlates more strongly than serum metal ion levels with pathology in periprosthetic tissues. 43 , 68 , 69 Some observers have correlated wear volume and ion levels with the predominance of a macrophage or lymphocyte response, 11 however, the extent of the macrophage infiltrate can be underestimated in the context of necrotic and inflammatory changes in periprosthetic tissues, and is often appreciated only after immunohistochemistry. 51 , 52 …”

Section: Adaptive Immune Reponse To Implant-derived Wearmentioning

confidence: 99%

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The pathobiology and pathology of aseptic implant failure

Athanasou

2016

Bone & Joint Research

113

104

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Pathological assessment of periprosthetic tissues is important, not only for diagnosis, but also for understanding the pathobiology of implant failure. The host response to wear particle deposition in periprosthetic tissues is characterised by cell and tissue injury, and a reparative and inflammatory response in which there is an innate and adaptive immune response to the material components of implant wear. Physical and chemical characteristics of implant wear influence the nature of the response in periprosthetic tissues and account for the development of particular complications that lead to implant failure, such as osteolysis which leads to aseptic loosening, and soft-tissue necrosis/inflammation, which can result in pseudotumour formation. The innate response involves phagocytosis of implant-derived wear particles by macrophages; this is determined by pattern recognition receptors and results in expression of cytokines, chemokines and growth factors promoting inflammation and osteoclastogenesis; phagocytosed particles can also be cytotoxic and cause cell and tissue necrosis. The adaptive immune response to wear debris is characterised by the presence of lymphoid cells and most likely occurs as a result of a cell-mediated hypersensitivity reaction to cell and tissue components altered by interaction with the material components of particulate wear, particularly metal ions released from cobalt-chrome wear particles.Cite this article: Professor N. A. Athanasou. The pathobiology and pathology of aseptic implant failure. Bone Joint Res 2016;5:162–168. DOI: 10.1302/2046-3758.55.BJR-2016-0086.

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Section: Innate Immune Response To Implant-derived Wearmentioning

confidence: 99%

Section: Innate Immune Response To Implant-derived Wearmentioning

confidence: 99%

Section: Adaptive Immune Reponse To Implant-derived Wearmentioning

confidence: 99%

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The pathobiology and pathology of aseptic implant failure

Athanasou

2016

Bone & Joint Research

113

104

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“…MoP implants generally produce a higher volume of wear particles than MoM implants, but the latter generate a larger number of particles, as metal particles are an order of magnitude smaller [55][56][57][58][59]. The adaptive immune system reacts differently to MoM and MoP implants: unlike MoM implants, a specific cell-mediated response to ultrahigh molecular weight polyethylene (UHMWP) does not appear to play a major role in MoP implant loosening.…”

Section: Orthopedic Implantsmentioning

confidence: 99%

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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The use of metals in the medical field has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as the stainless steel in surgical blades to internal exposure via medical devices being implanted in their bodies. There has been growing interest in the possibility of developing hypersensitivity reactions to constituent metals in medical implant devices, both in cutaneous and systemic forms. Hypersensitivity reactions to metals are uncommon, but they are reported and require appropriate evaluation and management, particularly if they are symptomatic. In view of the lack of consensus in the field on the appropriate steps to evaluate and manage patients with suspected metal hypersensitivity reactions, this review aims to analyze current evidence on hypersensitivity reactions to metallic implants in orthopedic surgery, endovascular surgery, obstetrics and gynecology, and dental surgery. Key words: Metal hypersensitivity. Metallic implants. ResumenEl empleo de metales dentro de la medicina ha ido aumentando de forma progresiva en las últimas décadas. Los pacientes se exponen a metales de diferentes formas desde fuentes externas, como instrumental quirúrgico como el presente en las hojas de acero de los bisturíes, hasta implantes metálicos. Como consecuencia de ello se está produciendo un interés creciente por la posibilidad de desarrollar reacciones de hipersensibilidad a metales presentes en los materiales y objetos implantados, tanto en forma de reacciones cutáneas como sistémicas. Las reacciones de hipersensibilidad a metales no son frecuentes, pero pueden desarrollarse, y por ello, requieren de un diagnóstico y tratamiento adecuado, especialmente en aquellos pacientes que desarrollen síntomas. No existe un consenso en el proceso diagnóstico ni en el tratamiento de estas reacciones en los pacientes con sospecha de alergia a metales. Esta revisión tiene por objeto actualizar la evidencia existente sobre las reacciones de hipersensibilidad a implantes metálicos en cirugía ortopédica, cirugía endovascular, cirugía obstétrica y ginecológica (OB-GYN) así como la dental. Palabras clave: Hipersensibilidad a metales. Implantes metálicos.

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Hypersensitivity to Hip and Knee Implants

Schalock

2018

Metal Allergy

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Benign Responses to Orthopaedic Implants: Really?

Cited by 3 publications

References 131 publications

The pathobiology and pathology of aseptic implant failure

The pathobiology and pathology of aseptic implant failure

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

Hypersensitivity to Hip and Knee Implants

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