Macrophage-colony stimulating factor (M-CSF) is increased in the synovial-like membrane of the periprosthetic tissues in the aseptic loosening of total hip replacement (THR)

The aim of the study was to assess the eventual presence, cellular localization and extent of expression of the osteoclast activating cytokine M-CSF (CSF-1) in the periprosthetic tissues around loose total hip replacement (THR). Synovial-like membrane was obtained from the implant-to-bone interface and pseudocapsule from ten total hip revisions performed for aseptic loosening and compared to ten hip synovial tissue samples obtained from ten patients who had primary THR for osteoarthritis. Avidin-biotinperoxidase complex (ABC) and alkaline phosphatase-anti-alkaline phosphatase (APAAP) methods were used for staining and VIDAS image analysis for quantification. M-CSF was mainly produced by macrophages, which often contained wear particles, but also by some fibroblasts and vascular endothelial cells. The number of cells containing (per one mm2 tissue) clearly increased in the interface (1585±212; p<0.01) and pseudocapsular (1456±248; p<0.01) tissue compared to synovial tissue (543±118). The present findings suggest, that inflammatory foreign-body type of response enhances expression of M-CSF in cases of aseptic loosening of THR. M-CSF produced in the synovial-like membrane in the implant-bone interface may contribute to activation of osteoclasts in periprosthetic bone and thus to loosening.