Interaction of materials and biology in total joint replacement – successes, challenges and future directions

Abstract

Total joint replacement (TJR) has revolutionized the treatment of end-stage arthritic disorders. This success is due, in large part, to a clear understanding of the important interaction between the artificial implant and the biology of the host. All surgical procedures in which implants are placed in the body evoke an initial inflammatory reaction, which generally subsides over several weeks. Thereafter, a series of homeostatic events occur leading to progressive integration of the implant within bone and the surrounding musculoskeletal tissues. The eventual outcome of the operation is dependent on the characteristics of the implant, the precision of the surgical technique and operative environment, and the biological milieu of the host. If these factors and events are not optimal, adverse events can occur such as the development of chronic inflammation, progressive bone loss due to increased production of degradation products from the implant (periprosthetic osteolysis), implant loosening or infection. These complications can lead to chronic pain and poor function of the joint reconstruction, and may necessitate revision surgery or removal of the prosthesis entirely. Recent advances in engineering, materials science, and the immunological aspects associated with orthopaedic implants have fostered intense research with the hope that joint replacements will last a lifetime, and facilitate pain-free, normal function.

Mutant CCL2 protein coating mitigates wear particle-induced bone loss in a murine continuous polyethylene infusion model

“…Wear particle-activated cells release pro-inflammatory cytokines and chemokines such as tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, prostaglandin E2 (PGE2), CCL2 and CCL3 [22]. Thus, the strategy to potentially mitigate inflammation induced by wear particles by interruption of the continuous recruitment of monocyte/macrophages from the circulation to the implant site by inhibiting the chemokine-receptor axis is an innovative therapeutic approach.…”

The effect of local IL‐4 delivery or CCL2 blockade on implant fixation and bone structural properties in a mouse model of wear particle induced osteolysis

“…Aseptic loosening remains one of the main long‐term complications of total joint replacement (TJR) surgery. Peri‐implant osteolysis and subsequent loosening of TJRs are driven by macrophage‐mediated inflammation to implant‐derived ultra‐high molecular weight polyethylene (UHMWPE) and other biomaterial wear particles . Wear particle‐activated macrophages secrete chemokines and pro‐inflammatory cytokines that lead to further macrophage recruitment, increased osteoclastogenesis, and suppression of osteoblast function .…”

Rheumatoid Arthritis: A Brief Overview of the Treatment

“…Lastly, a total joint replacement involves removing the damaged joint and replacing it with a metallic, plastic, or ceramic prosthesis. This is most commonly done in the shoulder, elbow, wrist, hip, knee, and ankle [46, 47]. The major contraindication for surgical joint replacements is the presence of active systemic articular infection.…”