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What to do about the growing concern of wear particles in spinal implants?

A critical review in iScience by Dr. Joanne L. Tipper (University of Technology Sydney) and Moreica Pabbruwe (Centre for Implant Retrieval and Analysis, Perth) puts spinal implant wear particles in the spotlight.

Detailed medical illustration presenting the biological impact of wear particles and metal ions in total disc replacement (TDR). The image is bifurcated into two sections: the left side visualizes various wear products and their associated biological responses; the right side highlights the implant design and biomaterial selection in mitigating wear.
Infographic illustrating the biological consequences of wear particles in total disc replacement (TDR), including pseudotumor formation, osteolysis, implant loosening and failure, infection, hypersensitivity reactions, cytotoxicity, and genotoxicity. Emphasizes the role of implant design and biomaterial selection—particularly PEEK-based materials and ceramics.

While hip and knee wear has been well documented, spinal wear remains under-investigated. This extensive review highlights the crucial roles of implant design (ball size, curvature, etc.) and materials in enabling – or preventing – wear.

What’s the background?

  • Spinal Total Disc Replacement (TDR) faces higher loads and wider motion and triggers stronger immune reaction than hips and knees.
  • Wear particles from TDRs are linked to osteolysis, inflammation, hypersensitivity, and even pseudotumors.

What did the team find?

  • PEEK-based materials and ceramics show lower rates of cytotoxicity.
  • Wear simulators are useful but must better replicate clinical reality.
  • Finite Element Modeling is emerging as a tool to predict wear behavior and guide design and surgical planning.
  • Current therapies targeting inflammation are not enough. They should also focus on neovascularization and discogenic pain pathways.
  • The authors call for better registry data, surgeon collaboration, and tissue access for deeper insight.

What does it mean for surgeons?

With over 30% of spinal implants revised within 10 years, it’s clear that understanding the biological effect of wear particles is critical. Spinal implant survival is not only about mechanics – it’s about biology, material science, and surgeon insight.
 

Please check for regulatory approval in your country.

References:

  • Ganko R, Madhavan A, Hamouda W, et al. Spinal implant wear particles: Generation, characterization, biological impacts, and future considerations. iScience. 2025;28(4):112193. Published 2025 Mar 11. doi:10.1016/j.isci.2025.112193
  • Porporati AA, Mödinger Y, Fischer S, et al. Zirconia-Toughened Alumina Ceramic Wear Particles Do Not Elicit Inflammatory Responses in Human Macrophages. Int J Mol Sci. 2023;24(7):6482. Published 2023 Mar 30. doi:10.3390/ijms24076482
  • Bylski D, Wedemeyer C, Xu J, Sterner T, Löer F, von Knoch M. Alumina ceramic particles, in comparison with titanium particles, hardly affect the expression of RANK-, TNF-alpha-, and OPG-mRNA in the THP-1 human monocytic cell line. J Biomed Mater Res A. 2009;89(3):707-716. doi:10.1002/jbm.a.31956
  • Warashina H, Sakano S, Kitamura S, et al. Biological reaction to alumina, zirconia, titanium and polyethylene particles implanted onto murine calvaria. Biomaterials. 2003;24(21):3655-3661. doi:10.1016/s0142-9612(03)00120-0
  • Hallab NJ, McAllister K, Brady M, Jarman-Smith M. Macrophage reactivity to different polymers demonstrates particle size- and material-specific reactivity: PEEK-OPTIMA(®) particles versus UHMWPE particles in the submicron, micron, and 10 micron size ranges. J Biomed Mater Res B Appl Biomater. 2012;100(2):480-492. doi:10.1002/jbm.b.31974
  • Stratton-Powell AA, Pasko KM, Brockett CL, Tipper JL. The Biologic Response to Polyetheretherketone (PEEK) Wear Particles in Total Joint Replacement: A Systematic Review. Clin Orthop Relat Res. 2016;474(11):2394-2404. doi:10.1007/s11999-016-4976-z

This text was created with the support of AI. 

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