Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty

Abstract

Background and purposeJoint replacement with metal-on-metal (MOM) bearings have gained popularity in the last decades in young and active patients. However, the possible effects of MOM wear debris and its corrosion products are still the subject of debate. Alongside the potential disadvantages such as toxicity, the influences of metal particles and metal ions on infection risk are unclear.MethodsWe reviewed the available literature on the influence of degradation products of MOM bearings in total hip arthroplasties on infection risk.ResultsWear products were found to influence the risk of infection by hampering the immune system, by inhibiting or accelerating bacterial growth, and by a possible antibiotic resistance and heavy metal co-selection mechanism.InterpretationWhether or not the combined effects of MOM wear products make MOM bearings less or more prone to infection requires investigation in the near future.

Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type?

“…The whole issue of surgical site infection is complex, and if ever there was good use for the word multifactorial, it would be to describe the possible causes of PJI. Adverse cellular reaction with inflammation and necrosis in the THA pseudocapsule can provide a favorable environment for bacterial proliferation, a potential reason as to why the incidence of PJI may be higher in THA with MoM bearings [6]. In contrast, the synovial-like pseudocapsule found in CoC THAs with fibrous tissue and limited inflammatory changes may potentially reduce the bioburden for late deep infection.…”

“…The 2015 New Zealand Joint Registry report identified PJI as the fifth most common reason for primary THA revision, accounting for 12% of THA revisions (452 of 3914 revisions); only dislocation, aseptic loosening of the acetabular component, aseptic loosening of the femoral component, and pain were more common [16]. Recently, the type of bearing surface and the potential association with infection have been the subject of investigation [6]. Limited observational data show a higher association of infection with metal-on-metal bearings than with other kinds [2].…”

The effects on bone cells of metal ions released from orthopaedic implants. A review

“…This results in progressive local osteolysis that threatens the fixation of the hardware (2). Whilst polyethylene degrades through wear alone, the metal alloys used in orthopaedic implants also degrade due to corrosion, or a combination of wear and corrosion (3,4).…”

Osteoblasts MC3T3-E1 Response in 2D and 3D Cell Cultures Models to High Carbon Content CoCr Alloy Particles. Effect of Metallic Particles on Vimentin Expression

“…However, particles are still produced as a result of wear and corrosion and this may cause osteolysis and eventually failure of the prosthesis (Billi et al, 2009;Hosman et al, 2010;Catelas et al, 2003). Following implantation, the responses that occur at the interface of a biomaterial and in the surrounding environment are important events in determining the biocompatibility of the implant.…”

“…This passive film prevents degradation of the alloys as is one of the kinetic barriers preventing implant corrosion (Arnholt et al, 2016). However, due to wear, electrochemical dissolution, or a combination of the 2 processes, micro and nanometric sizes wear particles are still produced and metallic ions are released from the prosthesis of the implanted patients (Billi et al, 2009;Hosman et al, 2010;Arnholt et al, 2016). Catelas et al (2003) have reported the necessity to carry out in vitro studies of the effects of these wear particles rather than the effect of CoCrMo particles on tissue response.…”