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World J Orthop. Nov 18, 2014; 5(5): 660-666
Published online Nov 18, 2014. doi: 10.5312/wjo.v5.i5.660
Metallic debris from metal-on-metal total hip arthroplasty regulates periprosthetic tissues
Christoph H Lohmann, Gurpal Singh, Hans-Georg Willert, Gottfried H Buchhorn
Christoph H Lohmann, Gurpal Singh, Department of Orthopaedic Surgery, Otto-von-Guericke University, 39120 Magdeburg, Germany
Gurpal Singh, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore 119228, Singapore
Hans-Georg Willert, Gottfried H Buchhorn, Department of Orthopaedics, University Hospital Goettingen, 37075 Göttingen, Germany
Author contributions: Lohmann CH, Singh G Willert HG and Buchhorn GH contributed to the study design, literature review, preparation and editing of this manuscript.
Correspondence to: Christoph H Lohmann, MD, Department of Orthopaedic Surgery, Otto-von-Guericke University, LeipzigerStrasse 44, 39120 Magdeburg, Germany.
Telephone: +49-391-6714000 Fax: +49-391-6713840
Received: December 28, 2013
Revised: June 20, 2014
Accepted: July 12, 2014
Published online: November 18, 2014
Core Tip

Core tip: Valuable lessons have been learnt from the era of metal-on-metal total hip arthroplasty. 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 is discussed, along with future research directions in this area.