“…Moreover, peptidoglycan, a PAMP produced by both Gram-negative and Gram-positive bacteria, exists in synovial tissue from patients with osteoarthritis and rheumatoid arthritis [16,96] and, therefore, likely exists in periprosthetic tissue of patients with aseptic loosening. One potential source of PAMPs during aseptic loosening is the bacteria present in the biofilms found on many loose implants despite the absence of clinical signs of infection [21,47,54,74,76,107,109]. Patients with inflammatory arthritis, especially those receiving anti-TNF-a therapies, may be especially at risk for formation of these bacterial biofilms [95].…”