title: Metallic debris from metal-on-metal total hip arthroplasty regulates periprosthetic tissues.
abstract: The era of metal-on-metal (MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to describe the tissue reactions. Sometimes the nomenclature can be confusing. We present a review of the concepts introduced by Willert and Semlitsch in 1977, along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. We propose that periprosthetic tissue reactions be thought of as (1) gross (metallosis, necrosis, cyst formation and pseudotumour); (2) histological (macrophage-dominated, lymphocyte-dominated or mixed); and (3) molecular (expression of inflammatory mediators and cytokines such as interleukin-6 and tumor necrosis factor-alpha). Taper corrosion and modularity are discussed, along with future research directions to elucidate the antigen-presenting pathways and material-specific biomarkers which may allow early detection and intervention in a patient with adverse periprosthetic tissue reactions to metal wear debris.
authors.affiliation: Christoph H Lohmann, Gurpal Singh, Department of Orthopaedic Surgery, Otto-von-Guericke University, 39120 Magdeburg, Germany.
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Lohmann
authors.affiliation: Christoph H Lohmann, Gurpal Singh, Department of Orthopaedic Surgery, Otto-von-Guericke University, 39120 Magdeburg, Germany.
authors.forename: Gurpal
authors.initials: G
authors.lastname: Singh
authors.affiliation: Christoph H Lohmann, Gurpal Singh, Department of Orthopaedic Surgery, Otto-von-Guericke University, 39120 Magdeburg, Germany.
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Willert
authors.affiliation: Christoph H Lohmann, Gurpal Singh, Department of Orthopaedic Surgery, Otto-von-Guericke University, 39120 Magdeburg, Germany.
authors.forename: Gottfried H
authors.initials: GH
authors.lastname: Buchhorn
keywords: Lymphocyte-dominated; Macrophage-dominated; Metal debris; Metal-on-Metal; Modularity; Periprosthetic tissue response; Taper corrosion; Total hip arthroplasty