The chronic inflammatory response to wear particles from orthopaedic
joint implants is believed to cause osteolysis and to contribute to
prosthetic loosening. Previous in vitro experiments have demonstrated that
particulate debris from joint implants causes cells in culture to release
products that have been implicated in this pathological bone resorption.
The purpose of the current study was to investigate the in vivo features of
this complex process in patients who had had a total hip replacement.
Membraneous tissue was obtained from the cement-bone interface of ten
polyethylene acetabular components that had been revised for aseptic
loosening in ten patients. The immunoperoxidase technique, which involves
the use of specific antibodies for each cell type, showed that macrophages
were the predominant cellular constituents but also that fibroblasts, many
of which were not identified on plain histological study, were present and
were actively producing collagen. T lymphocytes were present variably, but
they generally composed less than 10 percent of the cells. Particulate
debris (polyethylene, methylmethacrylate, and metal) was present in all
membrane specimens but was intracellular only in macrophages and
multinucleated giant cells. 35S-labeled nucleic-acid probes, complementary
to human interleukin-1-beta and to platelet-derived growth-factor-2
messenger RNA (mRNA), were hybridized with serial tissue sections.
Hybridization demonstrated interleukin-1-beta mRNA predominantly in
macrophages, and not in fibroblasts or in T lymphocytes to any major
extent. In contrast, immunolocalization demonstrated interleukin-1-beta
protein on both macrophages and fibroblasts, suggesting that macrophages
release interleukin-1-beta, which then binds to both fibroblasts and
macrophages. Platelet-derived growth-factor transcripts were found in both
macrophages and fibroblasts.