Total joint arthroplasty. Biologic causes of failure.

Hypersensitivity reactions and deep sepsis are the primary forms of biologic failure of total joint arthroplasty. Hypersensitivity reactions appear to be related to metal debris associated with metal articulating with metal arthroplasties. Although the incidence of deep sepsis following total joint arthroplasty is lower than initially feared, it remains a serious problem for both the patient and the surgeon. Fixation of prosthetic devices with methyl methacrylate appears safe. However, improved methods of fixation which are more compatible with osseous tissue are currently under study. The advantages of porous materials and the results of laboratory studies are reviewed.