Biological effects of wear particles generated in total joint replacements: trends and future prospects

Joint replacements have considerably improved the quality of life of patients with joints damaged by disease or trauma. However, problems associated with wear particles generated due to the relative motion between the components of the bearing are still present and can lead to the eventual failure of the implant. The biological response to wear debris affects directly the longevity of the prosthesis. The identification of the mechanisms by which cells respond to wear debris and how particles distribute into the human body may provide valuable information for the long term success of artificial joints. During the last few decades, orthopaedic research has been focused on predicting the in vivo performance of joint replacements. However, the exact relationship between material physicochemical properties and inflammatory response has not been fully understood. Laboratory wear simulators provide an accurate prediction of implant wear performance. Though, particles generated from such wear simulators require validation to compare them with particles extracted from peri-implant tissues. This review focuses initially on the current status of total joint replacements (hard on soft and hard on hard bearings) as well as on the tribological behaviour of the potential materials currently under investigation. Then, the correspondence between particles observed in vivo and those generated in vitro to predict the cellular response to wear debris is discussed. Finally, the biological effects of the degradation products generated by wear and corrosion are described.