Biological effects of wear particles generated in total joint replacements: trends and future prospects

Abstract

Joint replacements have considerably improved the quality of life of patients with joints damaged by disease or trauma. However, problems associated with wear particles generated due to the relative motion between the components of the bearing are still present and can lead to the eventual failure of the implant. The biological response to wear debris affects directly the longevity of the prosthesis. The identification of the mechanisms by which cells respond to wear debris and how particles distribute into the human body may provide valuable information for the long term success of artificial joints. During the last few decades, orthopaedic research has been focused on predicting the in vivo performance of joint replacements. However, the exact relationship between material physicochemical properties and inflammatory response has not been fully understood. Laboratory wear simulators provide an accurate prediction of implant wear performance. Though, particles generated from such wear simulators require validation to compare them with particles extracted from peri-implant tissues. This review focuses initially on the current status of total joint replacements (hard on soft and hard on hard bearings) as well as on the tribological behaviour of the potential materials currently under investigation. Then, the correspondence between particles observed in vivo and those generated in vitro to predict the cellular response to wear debris is discussed. Finally, the biological effects of the degradation products generated by wear and corrosion are described.

Tribocorrosion behaviour of hot pressed CoCrMo−Al2O3composites for biomedical applications

“…[5][6][7][8] Even though among all implant materials, CoCrMo alloys exhibit the most useful balance in strength, fatigue and wear, together with corrosion resistance, 9 wear debris generation and metallic ion releasing are still a major concern for CoCrMo implant materials. [10][11][12][13] It has been reported that the wear and corrosion products that are generated locally by the implant interfaces may lead to periprosthetic inflammation and implant loosening. 10,14 Besides, released metallic ions from the implant material may become clinically significant over the time, which may result in allergic reactions as well as contribute to implant failure and osteolysis.…”

Materials for Hip Prostheses: A Review of Wear and Loading Considerations

“…Wear particles occurring in MoP implants are within the size range required for phagocytosis by macrophages, which is considered to be a cause of aseptic loosening [126]. On the other hand, particles generated by MoM implants belong to the nanometer scale, which reduces macrophage reaction.…”

Immunological Responses to Total Hip Arthroplasty

“…For example, a large number of macrophages are identified in the interfacial membrane of patients, and these cells are actively phagocytosing the wear particles [ 31 ]. It was suggested that larger particles (>10 μm) can be engulfed by giant cells, while smaller particles would be phagocytosed by macrophages [ 32 ].…”