Immunological Responses to Total Hip Arthroplasty

Abstract

The use of total hip arthroplasties (THA) has been continuously rising to meet the demands of the increasingly ageing population. To date, this procedure has been highly successful in relieving pain and restoring the functionality of patients’ joints, and has significantly improved their quality of life. However, these implants are expected to eventually fail after 15–25 years in situ due to slow progressive inflammatory responses at the bone-implant interface. Such inflammatory responses are primarily mediated by immune cells such as macrophages, triggered by implant wear particles. As a result, aseptic loosening is the main cause for revision surgery over the mid and long-term and is responsible for more than 70% of hip revisions. In some patients with a metal-on-metal (MoM) implant, metallic implant wear particles can give rise to metal sensitivity. Therefore, engineering biomaterials, which are immunologically inert or support the healing process, require an in-depth understanding of the host inflammatory and wound-healing response to implanted materials. This review discusses the immunological response initiated by biomaterials extensively used in THA, ultra-high-molecular-weight polyethylene (UHMWPE), cobalt chromium (CoCr), and alumina ceramics. The biological responses of these biomaterials in bulk and particulate forms are also discussed. In conclusion, the immunological responses to bulk and particulate biomaterials vary greatly depending on the implant material types, the size of particulate and its volume, and where the response to bulk forms of differing biomaterials are relatively acute and similar, while wear particles can initiate a variety of responses such as osteolysis, metal sensitivity, and so on.

Inflammatory Response of Human Peripheral Blood Mononuclear Cells and Osteoblasts Incubated With Metallic and Ceramic Submicron Particles

“…An analysis of total hip revision data from different arthroplasty registries from around the world ( 2 ) showed that the 10-year risk for revision can range from 0.6 up to 66.5% depending on the type of endoprosthetic implants used. The majority of revision surgeries are due to aseptic implant loosening ( 3 ), which is associated with a non-specific foreign body response to non-biological influences, such as wear particles or with mechanical problems like stress-shielding ( 4 ). The biologic reaction to wear particles consequently leads to the induction of osteolytic processes in the implant surrounding tissue.…”

Macrophage Biocompatibility of CoCr Wear Particles Produced under Polarization in Hyaluronic Acid Aqueous Solution

“…Macrophages are a primary immune cell type and the main cellular type involved in inflammatory processes [ 1 ] and in host response [ 28 ], so their biologic host response to wear particles generated from the implanted materials is of great interest.…”

The USP14–NLRC5 pathway inhibits titanium particle–induced osteolysis in mice by suppressing NF-κB and PI3K/AKT activities

“…The long-term survivorship of THA is limited by wear particle-induced osteolysis, in which the monocyte/macrophage lineage cells play a pivotal role. The biotoxicity, biocompatibility and mechanics properties had been greatly renovated with the regeneration of prosthesis materials, but the aseptic loosening caused by wear particles still remain unsolved [1]. Upon activation by wear particles, macrophages release a series of proinflammatory cytokine like TNF-α, IL-6 and IL-1β which induce the recruitment of macrophage and trigger the activation of osteoclast precursors [4,5].…”

“…THA is a successful and widely used surgical procedure for the treatment of endstage degenerative and inflammatory osteoarthropathy. However, hip prosthesis only has an in-service life of 15-25 years, nearly all of the patients need to receive revision surgery in the end [1]. According to a complicationbased analysis using worldwide arthroplasty registers, the most common causes for revisions in THA were aseptic loosening(55.2%) [2].…”