The biological response to orthopedic implants for joint replacement. II: Polyethylene, ceramics, PMMA, and the foreign body reaction

Abstract

Novel evidence-based prosthetic designs and biomaterials facilitate the performance of highly successful joint replacement (JR) procedures. To achieve this goal, constructs must be durable, biomechanically sound, and avoid adverse local tissue reactions. Different biomaterials such as metals and their alloys, polymers, ceramics, and composites are currently used for JR implants. This review focuses on (1) the biological response to the different biomaterials used for TJR and (2) the chronic inflammatory and foreign-body response induced by byproducts of these biomaterials. A homeostatic state of bone and surrounding soft tissue with current biomaterials for JR can be achieved with mechanically stable, infection free and intact (as opposed to the release of particulate or ionic byproducts) implants. Adverse local tissue reactions (an acute/chronic inflammatory reaction, periprosthetic osteolysis, loosening and subsequent mechanical failure) may evolve when the latter conditions are not met. This article (Part 2 of 2) summarizes the biological response to the non-metallic materials commonly used for joint replacement including polyethylene, ceramics, and polymethylmethacrylate (PMMA), as well as the foreign body reaction to byproducts of these materials.

Tussilagone Inhibits Osteoclastogenesis and Periprosthetic Osteolysis by Suppressing the NF-κB and P38 MAPK Signaling Pathways

“…However, there were several limitations in our research. First, the mice used in this study, has limited cancellous bone, body volume and short lifespan, thus failed to simulate the coexistence of cancellous and cortex bone, decades of wearing period causing long-term inflammatory bio-scene in human body (Gibon et al, 2017), and hardly provided sufficient in vivo space and exercise load for implants in studies of their biomechanical properties. Moreover, we made an investigation on the local histology affected by TUS treatment in Ti particleinduced calvarial osteolysis animal model and no significant body weight loss, death or any adverse effect is observed in either control or TUS group in the animal experiment.…”

“…Second, Ti particle-induced calvarial osteolysis model, as we used, under-represents the wear-debris-induced osteolysis model used in the emulation of aseptic prosthetic loosening pathogenesis. Different types of wear particles found in the bone-graft interface of patients with different implant materials such as Ti (Eger et al, 2018), cobalt-chromium-molybdenum (CoCrMo) , ceramics (Gibon et al, 2017), tricalcium phosphate (Lv et al, 2016), polyether-ether-ketone (Du et al, 2018), highly cross-linked polyethylene, and ultrahigh-molecular-weight polyethylene (Ormsby et al, 2019) demonstrate various traits in osteolysis. In addition, the limitations that 30 mg Ti particles was locally administrated at one time to produce calvarial osteolysis model was discussed by Liu et al (Liu et al, 2014) in one of his study.…”

Role of implants surface modification in osseointegration: A systematic review

“…In addition, Al 2 O 3 is considered to be inert and exhibits osteogenic potential. It is reported that a fibrous membrane consisting mostly fibroblasts is induced when Al 2 O 3 is implanted (Gibon et al, 2017).…”

The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review

“…Third-body wear occurs when hard particles (such as PMMA, metal or bone) are entrapped between the femoral component and the polyethylene bearing surface [37]. Although generation of ultra-high molecular weight polyethylene (UHMWPE) particles are known to intensify osteolysis, PMMA cement particles, lead to accelerated wear and subsequent osteolysis as well [37][38][39][40][41]. Bitar et al [38] mentioned that the biological response of wear particles were dependent on both the particle and host characteristics such as size, composition and concentration.…”

“…Bitar et al [38] mentioned that the biological response of wear particles were dependent on both the particle and host characteristics such as size, composition and concentration. The PMMA mantle can be degraded macroscopically due to a number of factors such as microfracture within the bulk of the PMMA mantle over time, or the movement of bone and PMMA on the articulating surfaces [39,40]. These particles may or may not be phagocytosed depending on the particle size.…”