Role of cyclical pressure and particles in the release of M-CSF, chemokines, and PGE₂ and their role in loosening of implants

Abstract

A septic loosening of orthopaedic implants is usually attributed to the action of wear debris from the prosthesis. Recent studies, however, have also implicated physical pressures in the joint as a further cause of loosening. We have examined the role of both wear debris and pressure on the secretion of two chemokines, MIP-1alpha and MCP-1, together with M-CSF and PGE2, by human macrophages in vitro. The results show that pressure alone stimulated the secretion of more M-CSF and PGE2 when compared with control cultures. Particles alone stimulated the secretion of M-CSF and PGE2, when compared with unstimulated control cultures, but did not stimulate the secretion of the two chemokines. Exposure of macrophages to both stimuli simultaneously had no synergistic effect on the secretion of the chemokines, but both M-CSF and PGE2 were increased in a synergistic manner. Our findings suggest that pressure may be an initiating factor for the recruitment of cells into the periprosthetic tissue.

Cellular chemotaxis induced by wear particles from joint replacements

“…For TNF-α, MIP-1α, MCP-1, VEGF and IL-1ra, the expression levels for titanium discs were significantly higher than the corresponding expression levels for titanium particles and tissue culture plastic alone at 72 hours, possibly reflecting “frustrated phagocytosis”. Other researchers showed that “Ceridust” UHMWPE particles (mean particle size was 5.72 µm), or ambient pressure of 0.0345 MPa (5Psi) singularly or together had no effect on MIP-1α and MCP-1 release by monocytes isolated from healthy blood donors [29]. M-CSF and PGE2 levels were increased by both stimuli, and their application together was synergistic.…”

The local inflammatory environment and microorganisms in “aseptic” loosening of hip prostheses

“…In vitro studies demonstrate that macrophages produce “osteolytic” cytokines in response to pressure 5, 125, 126. McEvoy et al5 and Sampathkumar et al126 even demonstrated a synergistic effect of particles and pressure on cytokine release (IL‐1β, IL‐6, TNFα,5 M‐CSF, and PGE 2 126) in human monocytes/macrophages in vitro .…”

“…In vitro studies demonstrate that macrophages produce “osteolytic” cytokines in response to pressure 5, 125, 126. McEvoy et al5 and Sampathkumar et al126 even demonstrated a synergistic effect of particles and pressure on cytokine release (IL‐1β, IL‐6, TNFα,5 M‐CSF, and PGE 2 126) in human monocytes/macrophages in vitro . However, the pressures used in this study were fixed while in clinical patients with a hip implant, local pressures fluctuate between 0 mmHg when the joint is not used, 200 mmHg (0.027 MPa or 2.87 psi) by passive flexion and extension of the joint, and local pressure can even be as high as 700 mmHg (0.093 MPa or 13.54 psi) 5, 80, 127…”

La fixation acétabulaire sans ciment des prothèses totales de hanche de première intention

“…Moins la cupule est rigide, plus elle est susceptible de suivre les déformations élastiques du cotyle, mais plus elle est déformable avec les risques spécifiques des inserts des couples dur-dur [62] : défor-mation à l'équateur conduisant à la mise en place de l'insert sous contrainte. Le vissage, quant à lui, rigidifie le système et ajoute une interface ; il modifie la circulation des fluides et offre un chemin de migration aux débris d'usure [65,75]. Il paraît légitime d'obturer les orifices de vissage (ou de préhension) non utilisés [67].…”