Joint replacement surgery has a wide clinical application as a successful t
echnique. However, the release of biomaterial in particulate form from vari
ous implant components has been implicated as a cause of two major clinical
complications: 1)bone lysis with or without aseptic loosening, and 2) diss
emination of wear particles to distant sites with adverse local or systemic
cellular responses. This review focuses on the analysis of the clinical ma
terial obtained at the time of revision operations and its value in identif
ying the pathological processes taking place within the bone-implant microe
nvironment. Important issues discussed include the incidence of infection,
characterization of wear particles, particle-cell interactions, local histo
pathological changes that lead to the formation of erosive inflammatory les
ions next to the bone, sensitivity reactions, tumor formation, and the indu
ction of inflammatory factors and cytokines that can influence the rate of
bone resorption versus bone formation.