Editorial. A Potential Concern in Total Joint Arthroplasty: Systemic Dissemination of Wear Debris

This issue of The Journal contains an important article by Urban et al., which discusses the dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of patients who have had a total hip or knee replacement and focuses on the systemic effects rather than the local effects of a total joint arthroplasty12.

In a 1993 issue of The Journal, an editorial that I coauthored proclaimed that the problem in total joint arthroplasty was aseptic loosening5. Indeed, osteolysis and aseptic loosening are the most frequently recognized complications of total joint arthroplasty13. Much is known about the mechanical production of wear debris stimulating a biological response leading to osteolysis and, in many cases, to loosening of the implant.

In situ degradation of implants commonly occurs. The most prevalent form of such degradation is wear, but there also can be corrosion of the metallic components of the implant as well as a synergistic combination of wear and corrosion7. Debris is most commonly produced as a result of three primary forms of wear: adhesive, abrasive, and fatigue (also known as delamination)2. Such debris is produced at various sites, including the articular surface, modular implant junctions, and various interfaces such as implant-bone, implant-cement, and cement-bone interfaces.