Last time I checked – no one knows why titanium doesn’t elicit an immune response in most patients. Free TiO can even bioaccumlate in the event of mechanical stress ablating some surface oxidation. Anyhow, specifically why that material is ignored by the body is largely unknown.
It was observed by chance that it doesn’t and so we use that and ultra high weight polyethylene (high tensile strength, low surface deformation after casting, and oxidative resistance if mixed with antioxidants, eg. Vitamin e) – the latter not as good, but better at bone interface admittedly at the cost of oxidative stress susceptibility – but other answers already covered that
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