title: In situ complement activation by polyethylene wear debris.
abstract: A frequent long-term complication of total joint arthroplasty is aseptic loosening, the end result of wear debris accumulation, synovitis, and osteolysis about the implant-bone or cement-bone interface. Complement, an effector system in plasma, synovial fluid, and tissue, has powerful chemotactic, inflammatory, and osteoclast-activating potentials. This study explored the complement-activating ability of polyethylene, a material used in joint implants. In vitro hemolytic assays using sheep red blood cells (E(sh)), human serum, and particulate polyethylene suggested alternative pathway complement activation, as well as polyethylene adsorption of activated complement components. These results were confirmed by enzyme-linked immunosorbent assay (ELISA) quantification of activated complement factors Bb and C3b. In situ double antibody immunoperoxidase staining for factors Bb, C3a, iC3b, and SC5-9 in synovial tissue from revision hip specimens showed localized alternative pathway activation and component adsorption. These results introduce a likely role for complement activation in particle-mediated recruitment, proliferation, and activation of macrophages during early events in osteolysis and implant loosening.
authors.affiliation: Grand Rapids Orthopaedic Surgery Residency Program, 1840 Wealthy Street SE, Grand Rapids, Michigan 49506, USA. dehe@calvin.edu
authors.forename: D H
authors.initials: DH
authors.lastname: DeHeer
authors.forename: J A
authors.initials: JA
authors.lastname: Engels
authors.forename: A S
authors.initials: AS
authors.lastname: DeVries
authors.forename: R H
authors.initials: RH
authors.lastname: Knapp
authors.forename: J D
authors.initials: JD
authors.lastname: Beebe
mesh_terms: D001672:Biocompatible Materials / Q000009:adverse effects*; D002455:Cell Division / Q000187:drug effects; D003167:Complement Activation / Q000187:drug effects*; D003170:Complement Pathway, Alternative / Q000187:drug effects; D003171:Complement Pathway, Classical / Q000187:drug effects; D004797:Enzyme-Linked Immunosorbent Assay; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007150:Immunohistochemistry; D066298:In Vitro Techniques; D007595:Joint Prosthesis / Q000009:adverse effects*; D007840:Latex; D008262:Macrophage Activation / Q000187:drug effects; D008264:Macrophages / Q000187:drug effects; D010014:Osteolysis / Q000473:pathology; D020959:Polyethylene / Q000009:adverse effects*; D011475:Prosthesis Failure; D013582:Synovial Fluid / Q000166:cytology / Q000187:drug effects
chemical_list: D001672:Biocompatible Materials; D007840:Latex; D020959:Polyethylene