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

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. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1685-1691, 2017.

[1]  Y. Konttinen,et al.  Modulation of mouse macrophage polarization in vitro using IL-4 delivery by osmotic pumps. , 2015, Journal of biomedical materials research. Part A.

[2]  H. Rubash,et al.  Human macrophage response to UHMWPE, TiAlV, CoCr, and alumina particles: analysis of multiple cytokines using protein arrays. , 2008, Journal of biomedical materials research. Part A.

[3]  S. Gambhir,et al.  Effect of a CCR1 receptor antagonist on systemic trafficking of MSCs and polyethylene particle-associated bone loss. , 2012, Biomaterials.

[4]  S. Goodman,et al.  Continuous intramedullary polymer particle infusion using a murine femoral explant model. , 2008, Journal of biomedical materials research. Part B, Applied biomaterials.

[5]  D. Chappard,et al.  Free radicals and side products released during methylmethacrylate polymerization are cytotoxic for osteoblastic cells. , 1998, Journal of biomedical materials research.

[6]  P. Christel.  Biocompatibility of surgical-grade dense polycrystalline alumina. , 1992, Clinical orthopaedics and related research.

[7]  Diana Boraschi,et al.  Innate defence functions of macrophages can be biased by nano-sized ceramic and metallic particles. , 2004, European cytokine network.

[8]  S. Goodman,et al.  Local effect of IL-4 delivery on polyethylene particle induced osteolysis in the murine calvarium. , 2013, Journal of biomedical materials research. Part A.

[9]  W H Harris,et al.  Formation of a synovial-like membrane at the bone-cement interface. Its role in bone resorption and implant loosening after total hip replacement. , 1986, Arthritis and rheumatism.

[10]  J Fisher,et al.  Alumina-alumina artificial hip joints. Part I: a histological analysis and characterisation of wear debris by laser capture microdissection of tissues retrieved at revision. , 2002, Biomaterials.

[11]  S. Goodman,et al.  Validation and quantification of an in vitro model of continuous infusion of submicron-sized particles. , 2008, Journal of biomedical materials research. Part B, Applied biomaterials.

[12]  T. Webster,et al.  Increased viable osteoblast density in the presence of nanophase compared to conventional alumina and titania particles. , 2004, Biomaterials.

[13]  W. Maloney,et al.  Biomechanical and histologic investigation of cemented total hip arthroplasties. A study of autopsy-retrieved femurs after in vivo cycling. , 1989, Clinical orthopaedics and related research.

[14]  J. Klawitter,et al.  Effect of stress on tissue ingrowth into porous aluminum oxide. , 1974, Journal of biomedical materials research.

[15]  M. Longaker,et al.  The Foreign Body Response : At the Interface of Surgery and Bioengineering Special Topic , 2015 .

[16]  W. Maloney,et al.  Cellular profile and cytokine production at prosthetic interfaces. Study of tissues retrieved from revised hip and knee replacements. , 1998, The Journal of bone and joint surgery. British volume.

[17]  S. Goodman,et al.  Revision joint replacement, wear particles, and macrophage polarization. , 2012, Acta biomaterialia.

[18]  Rocky S. Tuan,et al.  What are the local and systemic biologic reactions and mediators to wear debris, and what host factors determine or modulate the biologic response to wear particles? , 2008, The Journal of the American Academy of Orthopaedic Surgeons.

[19]  H. Plenk,et al.  Extracortical attachment of bioceramic endoprostheses to long bones without bone cement. , 1978, Clinical orthopaedics and related research.

[20]  D. Zukor,et al.  Induction of macrophage apoptosis by ceramic and polyethylene particles in vitro. , 1999, Biomaterials.

[21]  M A Freeman,et al.  Bone formation and bone resorption in failed total joint arthroplasties: Histomorphometric analysis with histochemical and immunohistochemical technique , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[22]  S. Akira,et al.  Toll-like receptors: critical proteins linking innate and acquired immunity , 2001, Nature Immunology.

[23]  S. Goodman,et al.  The effects of titanium and polymethylmethacrylate particles on osteoblast phenotypic stability. , 2006, Journal of biomedical materials research. Part A.

[24]  D. Zukor,et al.  Flow cytometric analysis of macrophage response to ceramic and polyethylene particles: effects of size, concentration, and composition. , 1998, Journal of biomedical materials research.

[25]  W. Maloney,et al.  Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles. , 1999, The Journal of bone and joint surgery. British volume.

[26]  S. Goodman,et al.  Toll-like receptors-2 and 4 are overexpressed in an experimental model of particle-induced osteolysis. , 2014, Journal of biomedical materials research. Part A.

[27]  Laurent Sedel,et al.  Alumina-on-Alumina Total Hip Arthroplasty: A Minimum 18.5-Year Follow-up Study , 2002, The Journal of bone and joint surgery. American volume.

[28]  Laurent Sedel,et al.  Ceramics in total hip replacement. , 2005, Clinical orthopaedics and related research.

[29]  D. Hungerford,et al.  Cement disease. , 1987, Clinical orthopaedics and related research.

[30]  Jie Xu,et al.  Alumina ceramic particles, in comparison with titanium particles, hardly affect the expression of RANK-, TNF-alpha-, and OPG-mRNA in the THP-1 human monocytic cell line. , 2009, Journal of biomedical materials research. Part A.

[31]  D. Lindsey,et al.  An in vivo murine model of continuous intramedullary infusion of polyethylene particles. , 2008, Biomaterials.

[32]  Y. Konttinen,et al.  Macrophage polarization and activation in response to implant debris: influence by "particle disease" and "ion disease". , 2014, Journal of long-term effects of medical implants.

[33]  J. Gamble,et al.  IL-3 and granulocyte-macrophage colony-stimulating factor stimulate two distinct phases of adhesion in human monocytes. , 1990, Journal of immunology.

[34]  J. Anderson,et al.  Interleukin-4 induces foreign body giant cells from human monocytes/macrophages. Differential lymphokine regulation of macrophage fusion leads to morphological variants of multinucleated giant cells. , 1995, The American journal of pathology.

[35]  S. Goodman,et al.  In vivo murine model of continuous intramedullary infusion of particles--a preliminary study. , 2009, Journal of biomedical materials research. Part B, Applied biomaterials.

[36]  S. Goodman,et al.  Continuous Infusion of UHMWPE Particles Induces Increased Bone Macrophages and Osteolysis , 2011, Clinical orthopaedics and related research.

[37]  M. Lorenzato,et al.  In vitro reactions of human osteoblasts in culture with zirconia and alumina ceramics. , 1999, Journal of biomedical materials research.

[38]  D. Zukor,et al.  Cytotoxicity and macrophage cytokine release induced by ceramic and polyethylene particles in vitro. , 1999, The Journal of bone and joint surgery. British volume.

[39]  S. Goodman,et al.  The effects of bulk versus particulate polymethylmethacrylate on bone. , 1988, Clinical orthopaedics and related research.

[40]  S. Goodman,et al.  Macrophage polarization in response to wear particles in vitro , 2013, Cellular and Molecular Immunology.

[41]  P. Revell,et al.  Neovascularisation and the induction of cell adhesion molecules in response to degradation products from orthopaedic implants. , 1995, Annals of the rheumatic diseases.

[42]  S. Kurtz,et al.  The epidemiology of bearing surface usage in total hip arthroplasty in the United States. , 2009, The Journal of bone and joint surgery. American volume.

[43]  B. Chiang,et al.  Over-expression of receptor activator of nuclear factor-kappaB ligand (RANKL), inflammatory cytokines, and chemokines in periprosthetic osteolysis of loosened total hip arthroplasty. , 2010, Biomaterials.

[44]  H. Rubash,et al.  Assessing osteolysis with use of high-throughput protein chips. , 2007, The Journal of bone and joint surgery. American volume.

[45]  J Fisher,et al.  Comparison of the cytotoxicity of clinically relevant cobalt-chromium and alumina ceramic wear particles in vitro. , 2003, Biomaterials.

[46]  S. Goodman,et al.  The effects of bulk versus particulate ultra-high-molecular-weight polyethylene on bone. , 1988, The Journal of arthroplasty.

[47]  J. Galante,et al.  Bone resorption activity of particulate‐stimulated macrophages , 1993, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[48]  Y. Konttinen,et al.  Biocompatibility of total joint replacements: A review. , 2009, Journal of biomedical materials research. Part A.

[49]  J. Chevalier,et al.  In vitro and in vivo evaluation of an alumina-zirconia composite for arthroplasty applications. , 2010, Biomaterials.

[50]  S. Goodman,et al.  Role of macrophages in the biological reaction to wear debris from joint replacements. , 2014, Journal of long-term effects of medical implants.

[51]  Victor W H Ho,et al.  Derivation and characterization of murine alternatively activated (M2) macrophages. , 2009, Methods in molecular biology.

[52]  S. Goodman,et al.  Surveillance of systemic trafficking of macrophages induced by UHMWPE particles in nude mice by noninvasive imaging. , 2010, Journal of biomedical materials research. Part A.

[53]  S. Goodman,et al.  Cellular chemotaxis induced by wear particles from joint replacements. , 2010, Biomaterials.

[54]  L. Santambrogio,et al.  Endosomal damage and TLR2 mediated inflammasome activation by alkane particles in the generation of aseptic osteolysis. , 2009, Molecular immunology.

[55]  W. Maloney,et al.  Bone lysis in well-fixed cemented femoral components. , 1990, The Journal of bone and joint surgery. British volume.

[56]  S. Goodman,et al.  Polymethylmethacrylate particles inhibit osteoblastic differentiation of bone marrow osteoprogenitor cells. , 2006, Journal of biomedical materials research. Part A.

[57]  B. Brown,et al.  Macrophage polarization: an opportunity for improved outcomes in biomaterials and regenerative medicine. , 2012, Biomaterials.

[58]  S. Goodman,et al.  Effects of orthopedic polymer particles on chemotaxis of macrophages and mesenchymal stem cells. , 2010, Journal of biomedical materials research. Part A.

[59]  H. Bertram,et al.  Osteolysis in alloarthroplasty of the hip. The role of bone cement fragmentation. , 1990, Clinical orthopaedics and related research.

[60]  D. Rennick,et al.  Interleukin 4 induces cultured monocytes/macrophages to form giant multinucleated cells , 1988, The Journal of experimental medicine.

[61]  R. O’Keefe,et al.  What experimental approaches (eg, in vivo, in vitro, tissue retrieval) are effective in investigating the biologic effects of particles? , 2008, The Journal of the American Academy of Orthopaedic Surgeons.

[62]  N. Athanasou,et al.  Polymethylmethacrylate-induced inflammatory macrophages resorb bone. , 1992, The Journal of bone and joint surgery. British volume.

[63]  Roland Huet,et al.  Advances in zirconia toughened alumina biomaterials for total joint replacement. , 2014, Journal of the mechanical behavior of biomedical materials.

[64]  J. Charnley.  The reaction of bone to self-curing acrylic cement. A long-term histological study in man. , 1970, The Journal of bone and joint surgery. British volume.

[65]  Silvano Sozzani,et al.  The chemokine system in diverse forms of macrophage activation and polarization. , 2004, Trends in immunology.

[66]  E. Boynton,et al.  Changes in macrophage morphology and prolonged cell viability following exposure to polyethylene particulate in vitro , 2002, Microscopy research and technique.

[67]  N. Athanasou,et al.  Osteoclastic differentiation by mononuclear phagocytes containing biomaterial particles , 1998, Archives of Orthopaedic and Trauma Surgery.

[68]  C. Case,et al.  The in vitro genotoxicity of orthopaedic ceramic (Al2O3) and metal (CoCr alloy) particles. , 2010, Mutation research.

[69]  D. Murray,et al.  Arthroplasty implant biomaterial particle associated macrophages differentiate into lacunar bone resorbing cells. , 1996, Annals of the rheumatic diseases.

[70]  S. Goodman,et al.  Prostaglandin E2 levels in the membrane surrounding bulk and particulate polymethylmethacrylate in the rabbit tibia. A preliminary study. , 1990, Clinical orthopaedics and related research.

[71]  Long-Term Results of Alumina-on-Alumina Hip Arthroplasty for Osteonecrosis , 2003, Clinical orthopaedics and related research.

[72]  Y. Konttinen,et al.  Innate immune reactions in septic and aseptic osteolysis around hip implants. , 2014, Journal of long-term effects of medical implants.

[73]  S. Goodman,et al.  Fibroblast expression of C—C chemokines in response to orthopaedic biomaterial particle challenge in vitro , 2001, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[74]  S. Goodman,et al.  Selective inhibition of the MCP‐1‐CCR2 ligand‐receptor axis decreases systemic trafficking of macrophages in the presence of UHMWPE particles , 2012, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[75]  W. Harris,et al.  Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. , 1992, The Journal of bone and joint surgery. American volume.