Morphological characteristics of total joint arthroplasty-derived ultra-high molecular weight polyethylene (UHMWPE) wear debris that provoke inflammation in a murine model of inflammation.

Abstract

It is recognized that the chronic inflammation in peri-prosthetic tissue that contributes to implant failure frequently is provoked by the presence of wear debris. Some wear debris is inevitable because of the nature of the prosthesis, but not all patients develop severe inflammatory responses. The precise factors that mediate the severity of tissue inflammation to wear debris has yet to be fully defined. Because wear debris retrieved from peri-prosthetic tissue consists of a heterogeneous mixture of materials with various sizes and shapes, this study evaluated the influence of two major physical aspects of ultra-high molecular weight polyethylene (UHMWPE) wear debris (shape and surface texture) using a model of tissue inflammation. UHMWPE debris particulates recovered from 50 peri-prosthetic tissue samples were examined by scanning electron microscopy and categorized into four groups based upon aspect ratio and surface texture of the material. The four groups were defined as: 1) smooth and globular, 2) smooth and fibular, 3) rough and globular, and 4) rough and fibular. Histological analysis and ELISA assays were conducted to evaluate variations in cellular responses and cytokine production between the groups. The strongest expression of tumor necrosis factor alpha and interleukin-1 beta was found in tissues exposed to UHMWPE debris with both a rough surface texture and fibular shape, and this response was significantly elevated over debris particles with a smooth surface texture and globular shape. The data suggest that both shape and texture influence the severity of specific inflammatory responses and that rough debris surface texture exerts a marked effect on adverse tissue responses when combined with particles that have a sharp, elongated shape.