Increased cytokine secretion in patients with failed implants compared with patients with primary implants.

All total joint replacements generate wear debris; yet, some implant prostheses fail while others survive despite the presence of ultrahigh molecular weight polyethylene particulate. It was hypothesized that patients with failed hip implants who have osteolysis will secrete higher inflammatory cytokines than patients receiving total joint replacements. Our study evaluated the peripheral blood monocyte response to varying polyethylene particle volume ratios through cytokine quantification in two patient populations: patients having revision surgery for failed total hip replacements (failed implant group) and patients having primary total hip surgery for osteoarthritis of the hip (primary implant group). We observed elevation of all three proinflammatory cytokines tested (interleukin-6, interleukin-1, and tumor necrosis factor-alpha) in response to polyethylene particulate challenge when compared with the controls in both patient groups. The population with failed implants also had a higher absolute cytokine response to polyethylene exposure compared with the control patients having primary implants. These findings suggest that patients with failed implants have a greater inflammatory cytokine response to polyethylene than seen in patients with primary implants.