Aims

Tissue responses to debris formed by abrasion of polymethylmethacrylate (PMMA) spacers at two-stage revision arthroplasty for prosthetic joint infection are not well described. We hypothesised that PMMA debris induces immunomodulation in periprosthetic tissues.

The peri-prosthetic tissue response to wear debris is complex and influenced by various factors including the size, area and number of particles. We hypothesised that the ‘biologically active area’ of all metal wear particles may predict the type of peri-prosthetic tissue response.

Peri-prosthetic tissue was sampled from 21 patients undergoing revision of a small diameter metal-on-metal (MoM) total hip arthroplasty (THA) for aseptic loosening. An enzymatic protocol was used for tissue digestion and scanning electron microscope was used to characterise particles. Equivalent circle diameters and particle areas were calculated. Histomorphometric analyses were performed on all tissue specimens. Aspirates of synovial fluid were collected for analysis of the cytokine profile analysis, and compared with a control group of patients undergoing primary THA (n = 11) and revision of a failed ceramic-on-polyethylene arthroplasty (n = 6).

The overall distribution of the size and area of the particles in both lymphocyte and non-lymphocyte-dominated responses were similar; however, the subgroup with lymphocyte-dominated peri-prosthetic tissue responses had a significantly larger total number of particles.

14 cytokines (interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, IL-17, interferon (IFN)-γ, and IFN-gamma-inducible protein 10), chemokines (macrophage inflammatory protein (MIP)-1α and MIP-1ß), and growth factors (granulocyte macrophage colony stimulating factor (GM-CSF) and platelet derived growth factor) were detected at significantly higher levels in patients with metal wear debris compared with the control group.

Significantly higher levels for IL-1ß, IL-5, IL-10 and GM-CSF were found in the subgroup of tissues from failed MoM THAs with a lymphocyte-dominated peri-prosthetic response compared with those without this response.

These results suggest that the ‘biologically active area’ predicts the type of peri-prosthetic tissue response. The cytokines IL-1ß, IL-5, IL-10, and GM-CSF are associated with lymphocyte-dominated tissue responses from failed small-diameter MoM THA.

Cite this article: Bone Joint J 2015;97-B:917–23.

Aims: We wanted to investigate the association between risk factors recorded prospectively before primary hip replacement, and the risk for later revision hip surgery. Methods: During the years 1977–83 The National Health Screening Service in Norway conducted an investigation of risk factors for cardiovascular disease. 56,818 persons born 1925–42 were invited, and 92% participated. We matched these screening data with data from the Norwegian Arthroplasty Register concerning primary and revision hip arthroplasty. Results: We identified 504 men and 834 women who had received a primary total hip replacement after the screening. Of these 75 and 94 were revised during follow-up. Mean age at screening was 49 years; mean age at primary hip replacement was 62 years. Mean age at censoring was 68 years. Men vs women had a relative risk of 1.9 of undergoing hip revision during follow-up (95% CI 1.3–2.8). For each years increase in age at primary hip arthroplasty, the risk of revision surgery during follow-up decreased with 14% for men and 17% for women. Men who at screening had the highest level of physical activity during leisure had 5.5 times the risk of later revision, relative to those with the lowest level of physical activity (95% CI 1.0–31.9). Conclusions: Men have a higher risk for revision hip surgery. There is less risk of revision the older the patient is at primary hip arthroplasty. Men with intense physical activity at middle age are at increased risk of undergoing revision hip surgery before they are 70 years old.