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Abstract
The immune system modulates many key biological processes in humans. However, the
exact role of the immune system in particle-associated periprosthetic osteolysis is
controversial. Human tissue retrieval studies, in vivo and in vitro experiments suggest
that the immune response to polymer particles is non-specific and macrophage-mediated.
Lymphocytes may modulate this response. However direct lymphocyte activation by polymer
particle-protein complexes seems unlikely. However, metallic byproducts may complex
with serum proteins and lead to a Type IV, lymphocyte-mediated immune reaction. In
predisposed individuals, this reaction may rarely lead to persistent painful joint
effusions, necessitating debridement and excision of the bearing surfaces of the prosthesis.
In these patients, retrieved periprosthetic tissues exhibit histological evidence
of perivascular lymphocytic cuffing. These findings are worrisome, given the fact
that increasing numbers of metal-on-metal joint implants are being implanted in younger
more active individuals worldwide.