CORRInsights®: Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine

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Total disc replacements (TDRs) for the lumbar spine are intended to restore and preserve motion while eliminating pain in patients suffering from degenerative disc disease. Five-year results in randomized clinical trials versus fusion show that lumbar disc replacements generally reach these goals, with pain relief equal to or better than fusion, maintenance of motion at the replaced joint, and less adjacent level degeneration than observed adjacent to a fusion [1, 11, 13, 14]. However, as is true of any joint replacement, motion between the contacting surfaces while under load causes wear with an associated release of debris that can vary in size, shape, and chemical composition depending on the materials used for the bearing surfaces, the design of the joint articulation, and the tendency for wear to occur due to unintended mechanical damage such as impingement.
The local and systemic effects of the biological reactions elicited by wear debris have been studied extensively in replacements for synovial joints such as the hip and knee, but have garnered less attention for replacing a cartilaginous joint such as between the vertebral bodies [12]. Still, reports of osteolysis and adverse local tissue reactions (ALTRs) similar to those seen around hip and knee replacements have emerged [3], substantiating the continuing concern that the biological reaction to debris may be an important factor limiting the longevity of disc replacements. Veruva and colleagues have provided additional compelling evidence that these concerns are warranted, and have begun to explore the hypothesis that a link exists between the presence of debris in local tissues and evidence of biological responses consistent with increased pain.

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