In Vitro Analyses of the Toxicity, Immunological, and Gene Expression Effects of Cobalt-Chromium Alloy Wear Debris and Co Ions Derived from Metal-on-Metal Hip Implants

Abstract

Joint replacement has proven to be an extremely successful and cost-effective means of relieving arthritic pain and improving quality of life for recipients. Wear debris-induced osteolysis is, however, a major limitation and causes orthopaedic implant aseptic loosening, and various cell types including macrophages, monocytes, osteoblasts, and osteoclasts, are involved. During the last few years, there has been increasing concern about metal-on-metal (MoM) hip replacements regarding adverse reactions to metal debris associated with the MoM articulation. Even though MoM-bearing technology was initially aimed to extend the durability of hip replacements and to reduce the requirement for revision, they have been reported to release at least three times more cobalt and chromium ions than metal-on-polyethylene (MoP) hip replacements. As a result, the toxicity of metal particles and ions produced by bearing surfaces, both locally in the periprosthetic space and systemically, became a concern. Several investigations have been carried out to understand the mechanisms responsible for the adverse response to metal wear debris. This OPEN ACCESSLubricants 2015, 3 540 review aims at summarising in vitro analyses of the toxicity, immunological, and gene expression effects of cobalt ions and wear debris derived from MoM hip implants.

Cobalt (II) ions and nanoparticles induce macrophage retention by ROS-mediated down-regulation of RhoA expression

“…The production of CoCr alloy wear debris leads to phagocytosis of the particles by macrophages [28] . This metal debris with associated ions activate the monocyte/macrophage lineage to release a variety of mediators, such as free radicals, nitric oxide, tumour necrosis factor-α (TNF-α), interleukin-1 β (IL-1 β), prostaglandin E2 (PGE2) and IL-6 [29] , [30] , [31] , [32] , which are influenced by the concentrations, shape and size of the particles [4] . Metal debris and ions can sensitize the immune system by inducing a delayed type IV hypersensitivity response [33] .…”

Tribochemical Characterization and Tribocorrosive Behavior of CoCrMo Alloys: A Review

“…Notwithstanding that, the presence of protein may also present unfavorable consequences. In another study done by Yan et al [ 56 ], it was observed that the presence of protein could undeniably accelerate the formation of ions, such implants when used in vivo would have cytotoxic effects on the neighboring cells [ 74 , 75 ].…”

Harsh Sliding Wear of a Zirconia Ball against a-C:H Coated CoCrMo Disc in Hyaluronic Gel

“…The metallic CoCrMo is either just a part of the articulating joint, like the ball in a hip joint or the femur in a knee joint, or both articulating partners are made of metallic CoCrMo. Although artificial joint implants are produced on a high quality level already, some problems can arise from metallic ions or wear particles [2]. Blood cobalt and chromium levels of greater than 7 ppb (7 µg/L), point to potential for undesired soft tissue reaction [2].…”

“…Although artificial joint implants are produced on a high quality level already, some problems can arise from metallic ions or wear particles [2]. Blood cobalt and chromium levels of greater than 7 ppb (7 µg/L), point to potential for undesired soft tissue reaction [2]. Even if, the articulating part in the artificial joint is a softer polymer, like UHMWPE (ultra-high molecular weight polyethylene), the metallic counterpart suffers from wear.…”