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The response of primary human peripheral blood mononuclear phagocytes to challenge with clinically relevant ultra-high molecular weight polyethylene (UHMWPE) wear debris of known particle size and dose was evaluated. Particles with a mean size of 0.24, 0. 45, 1.7, 7.6, and 88 microm were cocultured with cells for 24 h before assessment of cell viability and production of the osteolytic cytokines interleukin (IL)-1 beta, IL-6, tumor necrosis factor-alpha, and granulocyte macrophage colony-stimulating factor, and prostaglandin E(2). All particle fractions were evaluated at particle volume (microm(3)) to cell number ratios of 10:1 and 100:1, which had been previously identified as being the most stimulatory and clinically relevant. None of the test fractions had an effect on cell viability. Whereas the heterogeneity of human individuals was clearly evident in the responses of the donors evaluated in this study (the response of donor 3 was between 5 and 20 times greater than the other donors), the most biologically active particles were found to be submicrometer in size. Stimulation with phagocytosable particles (0.24, 0.45, and 1.7 microm) resulted in enhanced levels of cytokine secretion. Macrophages stimulated with particles outside this size range produced considerably less cytokines at the volumes tested. These results confirm earlier findings and suggest that the size and volume of UHMWPE particles are critical factors in macrophage activation. Furthermore, they suggest that the heterogeneity of human individuals may be another important factor in determining implant life.

One hundred and twenty-nine Charnley acetabular components were acquired at the time of revision surgery and a tribological investigation undertaken. The relative occurrence of pitting in the unworn and worn regions of the sockets suggest that most of the cement ingress occurs during the early part of the service life. The penetration depth of the explanted sockets was determined using the shadowgraph technique. Observation of the profiles in the wear planes suggest that, in general, the creep component was not a significant proportion of the overall change in the inner bore of the socket. Using weighted ordinary least squares regression, in which the intercept was not assumed to be zero, mean penetration and wear volume rates of 0.02 (SE = 0.02) mm/year and 55 (SE = 5) mm3/year, respectively, were recorded and are in agreement with other retrieval studies. In neither case was the intercept found to be significantly different from zero. A mean clinical wear factor, Kclinical, equal to 2.1 (SE = 0.2) x 10(-6) mm3/N m was calculated which is considerably larger than that found in laboratory experiments which purport to reflect in vivo conditions. In this analysis, a significant positive intercept was observed [96 (SE = 36) mm3] and may be evidence of the small initial penetration due to creep reported in simulator experiments. A strong positive association between kclinical and the arithmetical mean roughness, Ra, of the femoral head was also demonstrated although the rate of change was not as great as that cited for laboratory experiments.

We report the findings from independent prospective clinical and laboratory-based joint-simulator studies of the performance of ceramic femoral heads of 22.225 mm diameter in cross-linked polyethylene (XLP) acetabular cups. We found remarkable qualitative and quantitative agreement between the clinical and simulator results for the wear characteristics with time, and confirmed that ceramic femoral heads penetrate the XLP cups at only about half the rate of otherwise comparable metal heads.In the clinical study, 19 hips in 17 patients were followed for an average of 77 months. In the hip-joint simulator a similar prosthesis was tested for 7.3 million cycles.Both clinical and simulator results showed relatively high rates of penetration over the first 18 months or 1.5 million cycles, followed by a very much lower wear thereafter. Once an initial bedding-in of 0.2 mm to 0.4 mm had taken place the subsequent rates of penetration were very small. The initial clinical wear during bedding-in averaged 0.29 mm/year; subsequent progression was an order of magnitude lower at about 0.022 mm/year, lower than the 0.07 mm/year in metal-to-UHMWP Charnley LFAs.Our results show the excellent tribological features of alumina-ceramic-to-XLP implants, and also confirm the value of well-designed joint simulators for the evaluation of total joint replacements.