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How has the biologic reaction to wear particles changed with newer bearing surfaces?

Dr. Jacobs is Professor and Chairman, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. Dr. Campbell is Director, Implant Retrieval Lab, J. Vernon Luck Sr. MD Orthopaedic Research Center, UCLA-Orthopaedic Hospital, Los Angeles, CA. Dr. Konttinen is Professor of Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.

*The Implant Wear Symposium 2007 Biologic Work Group included Thomas W. Bauer, MD, PhD, Joan Bechtold, PhD, Mathias Bostrom, MD, Patricia A. Campbell, PhD, Victor Goldberg, MD, Stuart B. Goodman, MD, PhD, Ed M. Greenfield, PhD, Joshua J. Jacobs, MD, Yrjö Konttinen, MD, PhD, Regis O’Keefe, MD, PhD, Francis Young-In Lee, MD, Edward M. Schwarz, PhD, Arun S. Shanbhag, PhD, MBA, Robert Lane Smith, PhD, Rocky S. Tuan, PhD, and J. Mark Wilkinson, PhD, FRCS(Tr&Orth).

Dr. Jacobs or a member of his immediate family has received research or institutional support from Zimmer, Wright, Medtronics, Spinal Motion, Archus, and AST, and is a consultant for or an employee of Zimmer, Wright, Medtronics, Spinal Motion, Archus, and AST. Dr. Campbell or a member of her immediate family has received research or institutional support from DePuy, Smith & Nephew, and Wright Medical Technology. Neither Dr. Konttinen nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Orthopaedic surgeons have new tools that address the problem of aseptic loosening and osteolysis, and these tools are now in widespread clinical use. Hard-on-hard bearing couples as well as metal-on–highly cross-linked polyethylene bearing couples have lower volumetric wear rates and represent promising solutions to reduce the prevalence of osteolysis and aseptic loosening in total joint arthroplasty. Volumetric wear rates alone, however, do not completely predict the osteolytic potential that is also a function of particle composition, size, morphology, and a number of other particle characteristics. Host factors, including differing innate reactivities to wear products and adaptive immune responses, remain important but incompletely defined. Although the toxicologic significance of local and systemic elevations in metal ions has not been definitively established, monitoring patients with metal-on-metal bearings with serum metal ion levels can be useful to determine the state of the bearing. Furthermore, optimization of these bearing systems to further diminish wear and corrosion would be highly desirable.