NDLI: How have new bearing surfaces altered the local biological reactions to byproducts of wear and modularity?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Bauer, Thomas W. Campbell, Patricia A. Hallerberg, Gretchen
Description	Author Affiliation: Bauer TW ( Departments of Pathology, Orthopaedic Surgery and The Spine Center, L25, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, Bauert@ccf.org.)
Abstract	BACKGROUND: The biologic reactions to byproducts of wear or corrosion can involve innate and adaptive processes and are dependent on many factors, including the composition, size, surface properties, shape, and concentration of debris. QUESTIONS/PURPOSES: We used a systematic literature review to compare the reported patterns of inflammation in tissues around total hip implants with the goal of identifying whether there are unique or characteristic patterns associated with the newer bearing options or modular components. METHODS: A search of the Ovid Medline database between 1996 and early December 2013 identified articles that compared the histology around six implant groups: (1) metal-on-metal; (2) ceramic-on-ceramic; (3) metal-on-crosslinked polyethylene; (4) metal-on-conventional polyethylene with or (5) without modularity; and (6) tissue obtained at primary arthroplasty. Our initial search yielded 865 citations. After excluding articles that lacked a quantitative or semiquantitative description of histologic findings in periprosthetic tissue, we reviewed 34 articles. RESULTS: No pattern of inflammation is specific for any given bearing combination. Histologic features suggestive of an adaptive immune response appear to be more frequent and of greater magnitude in failed metal-on-metal implants, but tissues around many failed metal-on-metal implants show features of an 'innate' foreign body reaction without lymphocytes. Occasional nonmetal-on-metal implants show features of an immune reaction, possibly associated with metal particles. Modular connections are one source of metal debris in nonmetal-on-metal implants. Features of an immune reaction appear rare in ceramic-on-ceramic implants that lack corrosion. Insufficient reports are available to characterize the biologic response to crosslinked polyethylene. CONCLUSIONS: All total hip bearing combinations will wear in vivo, and modular interfaces are a likely source of metal that may be associated with a biological response regardless of the composition of the bearing surfaces. Surgeons must weigh the potential advantages of each articular combination and modular connection with the potential adverse tissue reactions in any given patient. Additional work is needed to clarify the implant and host-related factors associated with adverse tissue reactions and that seem to induce an immune reaction in some patients.
File Format	HTM / HTML
ISSN	0009921X
e-ISSN	15281132
DOI	10.1007/s11999-014-3817-1
Journal	Clinical Orthopaedics and Related Researchtextregistered
Issue Number	12
Volume Number	472
Language	English
Publisher	Springer
Publisher Date	2014-12-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Orthopaedics Arthroplasty, Replacement, Hip Instrumentation Foreign-body Migration Etiology Hip Joint Surgery Hip Prosthesis Prosthesis Failure Adaptive Immunity Animals Adverse Effects Biomechanical Phenomena Ceramics Corrosion Diagnosis Immunology Physiopathology Immunity, Innate Metal-on-metal Joint Prostheses Polyethylene Prosthesis Design Risk Factors Stress, Mechanical Surface Properties
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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How has the introduction of new bearing surfaces altered the biological reactions to byproducts of wear and modularity?

What are the current clinical issues in wear and tribocorrosion?

The surgical options and clinical evidence for treatment of wear or corrosion occurring with THA or TKA.

How have alternative bearings and modularity affected revision rates in total hip arthroplasty?

What is the trouble with trunnions?

ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements. : Editorial

Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions?

What are the advantages and disadvantages of imaging modalities to diagnose wear-related corrosion problems?

CORR Insights®: can wear explain the histological variation around metal-on-metal total hips?

How have new bearing surfaces altered the local biological reactions to byproducts of wear and modularity?

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How has the introduction of new bearing surfaces altered the biological reactions to byproducts of wear and modularity?

What are the current clinical issues in wear and tribocorrosion?

The surgical options and clinical evidence for treatment of wear or corrosion occurring with THA or TKA.

How have alternative bearings and modularity affected revision rates in total hip arthroplasty?

What is the trouble with trunnions?

ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements. : Editorial

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