Polymethylmethacrylate and titanium alloy particles activate peripheral monocytes during periprosthetic inflammation and osteolysis

We investigated the interactions of particulate PMMA or titanium alloy, patient blood monocytes, and periprosthetic tissues using a SCID‐hu model of aseptic loosening. Periprosthetic tissues and bone chips obtained at revision surgery for loosening were transplanted into muscles of SCID mice. Peripheral blood monocytes (PBMCs) isolated from the same donors were fluorescently labeled and co‐cultured with PMMA or Ti‐6Al‐4V particles before intraperitoneal injection. Control mice with periprosthetic tissue or non‐inflammatory ligament xenografts received naive PBMCs transfusion. Mice were euthanized 2 weeks after PBMC transfusion. The human tissues were well accepted in SCID mice. Transfused fluorescent‐labeled PBMCs were markedly accumulated in transplanted periprosthetic tissues. Multinucleated osteoclast‐like cells were commonly seen within retrieved xenograft tissue, and focal bone erosions were ubiquitous. Total cell densities and CD68+ cells within the xenograft were significantly increased in mice transfused with PMMA and Ti‐provoked PBMCs compared to the naïve PBMC animals (p < 0.05). Immunohistochemical staining identified much stronger positive IL‐1 and TNF stains in xenografts from either PMMA or Ti‐stimulated monocytes transfusion groups (p < 0.05). TRAP+ cells were found around bone chips in both activated‐PBMCs groups, although markedly more aggregated TRAP+ cells in the PMMA‐challenged group than in the titanium group (p < 0.05). MicroCT assessment confirmed the significant decrease of bone mineral density in chips interacted with activated‐monocytes/osteoclasts. In conclusion, PMMA or titanium particles readily activate peripheral monocytes and promote the cell trafficking to the debris‐containing prosthetic tissues. Particles‐provoked PBMCs participated in and promoted the local inflammatory process, osteoclastogenesis, and bone resorption.