Allergenic reactions mechanism factors

Osteoclasts play a major role in bio-corrosion of orthopedic metal implants. Implant-derived metal ions enhance osteoclastic recruitment, maturation, survival and function. The metal ions also induce a peri-implant inflammation with accumulation of various immune cells. The metal ions form complexes with cellular proteins that become new antigens inducing allergenic reactions where T-lymphocytes play an essential role. Those immune cells produce various inflammatory cytokines that cause inflammation and pain. In addition, T-lymphocytes secrete RANK-L, an essential factor for osteoclast functions. Finally, the described mechanisms are probably responsible for a vicious cycle with enhanced peri-implant inflammation and pain, as well as enhanced osteoclastic bio-corrosion and peri-implant bone resorption culminating in implant loosening (Figure 3). 

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