Metallic debris from metal-on-metal total hip arthroplasty regulates periprosthetic tissues

Figure 1 The Willert-Semlitsch concept of clearance of wear debris by periprosthetic lymph channels. If production of wear debris exceeds the ability of the lymph channels to clear it, the debris then “spills” over into the effective joint space and initiates osteolytic pathways.

Figure 2 Plain radiograph showing early, progressive osteolysis in response to metallic wear debris.

Figure 3 Pathologic figure. A: Diffuse and perivascular lymphocytic infiltration (lymphocyte-dominated tissue response) seen in retrieved periprosthetic tissues from small-diameter metal-on-metal (MoM) total hip arthroplasties (THAs). Haematoxylin-eosin, magnification, × 10; B: Intracellular metal particles seen in retrieval tissues from large-diameter MoM THA. These particles may undergo intracellular corrosion. Haematoxylin-eosin, magnification, × 40.