Arthroplasty is a successful and nowadays essential surgery. In patients suffering from end-stage joint destruction due to osteoarthritis or secondary to rheumatoid arthritis (RA) or other conditions, it significantly improves quality of life by reducing pain, restoring function, and increasing physical activity. Rather infrequently, metals released from implant materials cause local and systemic complications.

Peri-implant osteolysis is a highly prevalent non-infectious local complication and known to be driven by chronic innate immune responses to wear particles, whereas the pathogenesis of rarely occurring acute or chronic inflammation due to delayed type hypersensitivity (DTH) is mediated by an adaptive immune response. In early-onset osteolysis both processes are described to be tightly intertwined. Classical symptoms of an acute periprosthetic joint inflammation are most commonly related to bacteria induced periprosthetic joint infection (PJI).

After microbiological exclusion of septic complications, the differential diagnosis of sterile metal-related hypersensitivity remains conceivable. Multiple factors influence the outcome of the inflammatory processes and their biological consequences, such as elemental composition and chemical speciation of wear debris, exposure level and exposure duration as well as the local environment. Materials used in arthroplasty hold the potential to induce DTH reactions. In particular, metals such as nickel, cobalt and chromium are attributed to DTH, whereas the chemical speciation and protein interaction of these metals determine their immunogenicity.

Metal ions and particles released due to corrosion processes are linked to adaptive immune responses in arthroplasty. Titanium, cobalt and chromium-containing particles were detected in periprosthetic compartments with cobalt and chromium present in the non-particulate/ionic state. Beside metal ions, other compounds used in arthroplasty like initiators of the polymerization of methyl methacrylate (bone cement) are known sensitizers. Antibiotic additives of bone cement are also known to have sensitization capacity.

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Regards,

Stella

Editorial Team

Journal of Orthopedic Oncology