CHRONIC RESPONSE TO IMPLANTS Persistence of macrophages* at the implant surface Presence of fibroblasts x Proliferation and increased matrix synthesis of fibroblasts can result from mechanical perturbation by the implant or by agents released by the implant, leading to an increase in the thickness and density of the scar tissue. Fibroblast contraction can result in scar contracture Constituents of synovium
CHRONIC RESPONSE TO IMPLANTS CHRONIC RESPONSE TO IMPLANTS • Persistence of macrophages* at the implant Persistence of macrophages* at the implant surface surface • Presence of fibroblasts* Presence of fibroblasts* • Proliferation and increased matrix synthesis of Proliferation and increased matrix synthesis of fibroblasts can result from mechanical fibroblasts can result from mechanical perturbation by the implant or by agents perturbation by the implant or by agents released by the implant, leading to an increase in released by the implant, leading to an increase in the thickness and density of the scar tissue. the thickness and density of the scar tissue. • Fibroblast contraction can result in scar Fibroblast contraction can result in scar contracture. contracture. * Constituents of synovium * Constituents of synovium
MACROPHAGE AND FIBROBLAST INTERACTIONS IN SYNOVIUM Ions Mechanical force Endocytosis Macrophage part Sol, Part Reg Mitosis Fibroblast ECM t res Migration Fibroblast Ecm reg Synthesis Fibroblast ECM reg Contraction Fibroblast Ecm reg
MACROPHAGE AND FIBROBLAST MACROPHAGE AND FIBROBLAST INTERACTIONS IN SYNOVIUM INTERACTIONS IN SYNOVIUM Macrophage + Part. Sol. Part + Macrophage + Part. Sol. Part + Reg . Endocytosis Endocytosis Fibroblast + ECM + Fibroblast + ECM + Reg . Fibroblast + ECM + Fibroblast + ECM + Reg . Fibroblast + ECM + Fibroblast + ECM + Reg . Fibroblast + ECM + Fibroblast + ECM + Reg . Mitosis Mitosis Migration Migration Synthesis Synthesis Contraction Contraction Ion s Mechanical force Mechanical force