Neutrophils are active in total joint implant loosening

Abstract

Background Polymorphonuclear neutrophils (PMN)are the first cells to take part in the local foreign body reaction in aseptic loosening of endoprostheses. The aim of this study was to evaluate the systemic host reaction to total joint replacement by measuring the production of nitric oxide by neutrophils before and after total joint replacement.Patients and method Blood samples were collected from 33 patients (27 hips and 6 knees) before surgery, and 2 weeks, 2 months and 2.5-3 years after surgery. The levels of nitric oxide produced by PMN were measured by the method described by Markert et al. (1994).Results Patients reporting pain in the region of the implant 3 years after surgery, and also patients with radiographic signs of loosening, had higher production of NO in the early period and 3 years after the implantation than those with good clinical results.Interpretation We propose that elevated levels of nitric oxide production by PMNs may serve as a marker of total joint prosthesis loosening.

Nitric Oxide Activates Signaling by c-Raf, MEK, p-JNK, p38 MAPK and p53 in Human Mesenchymal Stromal Cells inhibits their Osteogenic Differentiation by Blocking Expression of Runx2

“…Oxidative stress plays an important role in aseptic loosening of orthopaedic endoprostheses [67,68] and high-output production of NO by CD68 + cells in the interface membrane was recorded [69,70]. We provide evidence that the elevated production of NO blocks the osteogenic differentiation of MSC by reducing the expression of Runx2 [54,71].…”

A preliminary in vitro and in vivo study of the effects of new anthraquinones on neutrophils and bone remodeling

“…Moreover, even if research on periprothetic osteolysis has focused mainly on the role of macrophages as the cells mostly responsible for the chronic inflammation in aseptic loosening, neutrophils may be not only involved in the initial phagocytic response to implanted materials but also contribute to a sustained cell loop, which involves persistent release from macrophages of chemokines and cytokines (e.g., TNF‐alpha) able to further recruit and activate neutrophils, both directly and by a priming mechanism 13, 14. Actually, the ability of a chemokine, such as interleukin‐8, to stimulate primed neutrophils has been demonstrated 27…”

“…In fact, even if macrophages have a central role in the inflammatory process causing periprosthetic osteolysis and loosening, neutrophils have been suggested to participate in this process due to the ability of cytokines and chemokines released by macrophages to recruit and activate the same neutrophils 13, 14…”

“…Complex interactions between phagocytes and other cells stimulating bone resorption and suppressing bone formation at the prosthetic interface have also been postulated 13, 14. Consequently, as the second part of the study, we perfomed a preliminary in vivo evaluation of the drug effects on bone remodeling, by employing a rat experimental model.…”

Biomarkers in Arthroplasty: A Systematic Review

“…[30] prospectively found significantly higher nitrous oxide (NO) production from stimulated peripheral neutrophils 2 months and 2-3 years post-operatively in patients with pain compared to patients without pain following primary knee or hip arthroplasty.…”