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Journal of Long-Term Effects of Medical Implants

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2017011287
pages 303-309

The Role of Macrophages in the Biological Reaction to Wear Debris from Artificial Joints

Christophe Nich
Laboratoire de Biomecanique et Biomateriaux Osteo-Articulaires − UMR CNRS 7052, Faculte de Medecine - Universite Paris 7, Paris, France; Department of Orthopaedic Surgery, European Teaching Hospital, Assistance Publique − Hopitaux de Paris
Yuya Takakubo
Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, Yamagata, 990-9585, Japan
Jukka Pajarinen
Department of Medicine, Institute of Clinical Medicine, Helsinki University Central Hospital, 00029 HUS, Finland; Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
Jiri Gallo
Department of Immunology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic; Department of Orthopaedics, Teaching Hospital, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
Yrjo T. Konttinen
Department of Orthopaedics, Teaching Hospital, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic; Department of Orthopaedics, ORTON Orthopaedic Hospital, 00280 Helsinki, Finland; COXA Hospital for Joint Replacement, 33520 Tampere, Finland
Michiaki Takagi
Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, Yamagata, 990-9585, Japan
Stuart B. Goodman
Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA

ABSTRACT

Normal usage of total joint replacements results in the production of wear debris and other byproducts. In particular, polyethylene particles are heavily involved in the stimulation of local and systemic biological reactions resulting in chronic inflammation, periprosthetic bone resorption (osteolysis), and eventually implant loosening. As sentinels of the innate immune system, cells of the monocyte/macrophage lineage initiate the inflammatory cascade that lead to osteolysis. The biological processes involved are complex, based on the unique properties of the monocytes/macrophages, including sensing, chemotaxis, phagocytosis, and adaptive stimulation. The interaction with wear debris triggers the release of pro-inflammatory factors such as tumor necrosis factor-α, interleukin-1, and others; pro-osteoclastic factors such as RANKL; and chemokines such as MCP-1 and MIP-1, all of which are crucial to the recruitment, migration, differentiation, and ultimately activation of bone-resorbing osteoclasts. In parallel, other distinct macrophage populations inhibit inflammation and mitigate its consequences on the bone–implant interface. Here, the role of the monocyte/macrophage cell lineage in the initiation and maintenance of the host inflammatory response to wear debris and subsequent periprosthetic osteolysis is presented.