Sensitivity to titanium. A cause of implant failure?

Abstract

Tissues from five patients who underwent revision operations for failed total hip replacements were found to contain large quantities of particulate titanium. In four cases this metal must have come from titanium alloy screws used to fix the acetabular component; in the fifth case it may also have originated from a titanium alloy femoral head. Monoclonal antibody labelling showed abundant macrophages and T-lymphocytes, in the absence of B-lymphocytes, suggesting sensitisation to titanium. Skin patch testing with dilute solutions of titanium salts gave negative results in all five patients. However, two of them had a positive skin test to a titanium-containing ointment.

Titanium uptake, induction of RANK‐L expression, and enhanced proliferation of human T‐lymphocytes

“…17 Aseptic loosening is suggested to result from inflammatory and hypersensitivity responses to metals, which lead to increased osteolytic activity at the bone-implant interface and ultimately loss of fixation. 5,6,14,15,[18][19][20] However, little is known about the effects of Ti(IV) ions on human T-lymphocytes, because most published studies have focused on other cells (such as macrophages, osteoblasts, and osteoclasts) and other metal ions. 21 It is well recognized that titanium degradation products including Ti(IV) ions are released by biocorrosion and accumulate in lymphoid tissues.…”

“…21 It is well recognized that titanium degradation products including Ti(IV) ions are released by biocorrosion and accumulate in lymphoid tissues. 11,13,14,22,23 However, this is the first study using EFTEM analysis, which is recognized as the gold standard in identifying titanium availability in biological specimens, 24 to demonstrate the ability of human T-lymphocytes to take up Ti(IV). EFTEM results indicate a strong Ti(IV) affinity for phosphorus-containing molecules such as the euchromatin in the nucleus, ribosomes in the cytoplasm, and phospholipids in the cell membrane.…”

“…In patients with titanium implants (used for osteosynthesis and prosthetic), infiltration of peri-implant tissues with macrophages and T-lymphocytes, along with minor skin sensitivity has been shown. 14,15 Despite this, little is known about the mechanisms of aseptic loosening of titanium implants and what role T-lymphocytes may play in a titaniumrelated inflammatory process in joints and bone.…”

Cellular profile and cytokine production at prosthetic interfaces

“…Thus, the prosthetic interface provides a complex series of interactions of cells, cytokines and other substances which modulate bone remodelling. With cemented implants, differences were also found in the T-lymphocyte subgroups, suggesting a possible role for immunological processes in osteolysis, but this is con- troversial and there are studies which advocate 21,32,[43][44][45][46][47][48] and refute [49][50][51][52][53][54] a role for T-cell modulation of the macrophage response to biomaterials. 55,56 With cementless prostheses there were fewer differences in cell number and cytokine profile in the various groups.…”

Improved Biocompatibility of Titanium–Zirconium (Ti–Zr) Alloy: Tissue Reaction and Sensitization to Ti–Zr Alloy Compared with Pure Ti and Zr in Rat Implantation Study

“…After 8 months' implantation to a subcutaneous position, the reaction of the tissue around the specimen was studied hematologically and histologically. Since cases of sensitization to pacemakers which are made of Ti have been reported, 27,28) we topically applied a metal salt solution to rats in order to detect hypersensitivity to the metal. Further, the in vitro proliferation of spleen lymphocytes was also measured to evaluate immune system activity.…”