Tumour necrosis factor (TNF) is considered to be the initiator protein of particle disease leading to aseptic loosening of endoprostheses. The aim of the present study was to investigate the TNF response of the macrophage-like cells (MLC) to the periprosthetic particles typically found during revision surgery. For this purpose, particles of polyethylene (PE), pure titanium (Ti), chromium (Cr), cobalt (Co), alumina ceramic (Al2O3) and zirconium dioxide (ZrO2) were used. Additionally, the therapeutic effect of non-steroidal and steroidal drugs, biphosphonates and pentoxyfylline on PE particles was investigated with the aim of differentiating drugs with, from those without, a positive effect on aseptic loosening.
Method: In an established macrophage model (Rader et al. 1999), THP1 cells (human monocytic cell line) were differentiated over a period of five days in the presence of vitamin D3 and GM-CSF in macrophage-like cells (MLC). To obtain a TNF profile of the different materials, 10(6) MLC were incubated with each of a range of different particle concentrations. For drug testing purposes 80 x 10(8) PE particles, which evoked a maximum TNF response, were applied together with increasing drug concentrations in the same manner. The supernatant was then investigated for TNF secretion using ELISA.
Results: It was found that the greatest TNF response was provoked by Co and PE particles, and was 25 and 23 times as high, respectively, in comparison with control. The smallest TNF secretion was seen with Al2O3 (4 x control) and ZrO2 (5 x control). At the recommended dose, non-steroidal anti-inflammatory drugs (NSAIDs) produced no decrease in TNF secretion. The biphosphonates, etidronate and ibendronate significantly reduced the TNF response of the PE-stimulated macrophages (by 1/7 and 1/5, respectively). Therapeutic doses of pentoxyfylline also led to a decrease of 1/5 in maximum TNF release.
Conclusion: Ceramic articulating surfaces are superior to metal/metal or PE/PE matings in terms of the biological effects of their wear particles. At therapeutic doses, NSAIDs have no beneficial effect on the process of aseptic loosening. Certain biphosphonates and pentoxyfylline have a positive effect on aseptic loosening.