Evaluation of the tissue response to the wear products of the hip joint endo-arthroprosthesis.

The causes of tissue reaction surrounding heterogeneous materials are: cell-mediated hypersensitivity due to an implant material; infection; post-surgery hematoma, following lysis of red cells and deposition of hemosiderin; "True" implant reaction, i.e., tissue modifications produced by wear particles of components of the prosthetic devices used. The stages of inflammation due to wear particles are: phagocytosis of particles by newly formed fibrous capsule cells; lymphatic drainage of particles through the newly formed joint capsule; granulation tissue reaction in the internal surface of the joint capsule which stores non-removed particles from inadequate drainage; necrosis of granulation tissue in contacting the artificial joint surface; formation of free masses of necrotic tissue in the joint cavity; formation of new granulation tissue due to these necrotic masses and by wear particles liberated from them (the beginning of a vicious cycle); insufficient storage by granulation tissue; formation of "auxiliary" granulation tissue in the fibrous layer of the bone-cement interfaces and in the R.E.S. of the bone-marrow; bone resorption and its replacement by granulation tissue; loosening of the prosthesis.