Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.172
Peer-review started: April 12, 2014
First decision: April 28, 2014
Revised: September 24, 2014
Accepted: October 14, 2014
Article in press: October 16, 2014
Published online: March 18, 2015
Core tip: After a comprehensive review of joint arthroplasty history, this article outlines the fundamental pathophysiology of the debris-induced biological reaction common to all particles types. Furthermore, specific characteristics of polyethylene, metal, ceramic, and polymethylmethacrylate particles are stated separately with their associated clinical relevance. Lastly, future therapeutic strategies to down-regulate periprosthetic osteolysis are enumerated, including anti-inflammatory agents used to modulate the cytokines release, anti-osteolytic agents used to disintegrate osteoclasts morphology, and antioxidants used to demolish the free oxygen radicals produced by the activated macrophages. The reader will find an extensive literature review encompassing all aspects of the debris-induced hostile cellular reaction.