Metal-Specific Biomaterial Accumulation in Human Peri-Implant Bone and Bone Marrow

Metallic implants are frequently used in medicine to support and replace degenerated tissues. Implant loosening due to particle exposure remains a major cause for revision arthroplasty. The exact role of metal debris in sterile peri-implant inflammation is controversial, as it remains unclear whether and how metals chemically alter and potentially accumulate behind an insulating peri-implant membrane, in the adjacent bone and bone marrow (BM).
The obtained data demonstrate that metals released from various arthroplasty implants lead to multi-elemental exposure in surrounding bone and BM. In summary, Cr distinctively accumulates in matrix structures of peri-implant BM, Co and Cr integrate into the peri-implant cancellous bone and Ti particles were predominantly found in peri-implant regions of the BM affected by fibrotic and inflammatory changes.

The rather low oxidative stability of the CoCrMo alloy compared to other implant materials and associated concerns have led to the development and launch of many alternative implant materials in recent years. In the field of THA, CoCrMo-free implants are becoming increasingly important. Long-term data from implant registries confirm satisfactory results of CoCrMo-free THA.[67] In TKA, CoCrMo-free implants and corresponding long-term data are not yet available to the same extent as in THA.

Despite problems regarding local metal dissolution and systemic distribution of Co and Cr ions, local persistency of more stable debris, that is, consisting of TiO2, must also be considered. We are convinced that risk-benefit evaluation of medical devices should not only comprise biocompatibility testing of bulk materials but also of wear and corrosion products.

Author(s)Source
Schoon J, Hesse B, Rakow A, Ort MJ, Lagrange A, Jacobi D, Winter A, Huesker K, Reinke S, Cotte M, Tucoulou R Marx U et al.Advanced Science Wiley Online Library, https://doi.org/10.1002/advs.202000412
(deutsch)
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