Acute Sciatic Nerve Palsy Caused by a Polyethylene Granuloma Arising From a Well-fixed Total Knee Arthroplasty

Waite, Jonathan; Marks, Paul; Young, David

doi:10.1016/j.arth.2005.11.005

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…The fact is that neuropathies have been reported around both well-functioning and failing articulating implants, but were generated from a granulomatus (immune) response to implant debris, not directly from the implant debris. 121 – 123 Patients have been reported to develop pain and inflammation of unknown etiology associated with spinal implants (screws) and shown resolution after implant removal. 94 , 95 However, adjacent tissues in these case studies of spinal implants have shown the presence of synovial-like granulomatous tissue, osteolysis, and elevated inflammatory mediators such as PGE2 speculated to be produced by the micromotion or debris of implants, such as a loose pedicle screw.…”

Section: Resultsmentioning

confidence: 99%

A review of the biologic effects of spine implant debris: Fact from fiction

Hallab¹

2009

SAS Journal

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BackgroundBiologic-reactivity to implant-debris is the primary determinant of long-term clinical performance. The following reviews: 1) the physical aspects of spinal-implant debris and 2) the local and systemic biologic responses to implant debris.MethodsMethods included are: 1) gravimetric wear analysis; 2) SEM and LALLS; 3) metal-ion analysis; 4) ELISA, toxicity testing, patch testing; and 5) metal-lymphocyte transformation testing (metal-LTT).ResultsWear and corrosion of spine-implants produce particles and ions. Particles (0.01–1000 μm) are generally submicron ( <1 µm). Wear rates of metal-on-polymer and metal-on-metal disc arthroplasties are approximately 2–20 and 1 mm3/yr, respectively. Metal-on-metal total disc replacement components have significant increases in circulating metal (less than 10-fold that of controls at 4 ppb-Co and 3 ppb-Cr or ng/mL). Debris reactivity is local and systemic. Local inflammation is caused primarily by ingestion of debris by local macrophages, which produce pro-inflammatory cytokines TNFα, IL-1β, IL-6, and PGE2. Systemic responses associated with implant-debris have been limited to hypersensitivity reactions. Elevated amounts of in the liver, spleen, etc of patients with failed TJA have not been associated with remote toxicological or carcinogenic pathology to date. Implant debris are differentially bioreactive. Greater numbers are pro-inflammatory; the smaller-sized debris are more bioreactive by virtue of their greater numbers (dose) for a given amount of implant mass loss (one 100-μm-diameter particle is equivalent in mass to 1 million 1-μm-diameter particles). Elongated particles are pro-inflammatory (ie, aspect ratio of greater than 3). Metal particles are more proinflammatory than polymers, ceteris paribus.ConclusionSpinal arthroplasty designs have been in use for more than 20 years internationally; therefore, concerns about neuropathology, toxicity, and carcinogenicity are mitigated. Debris-induced inflammation still depends on the individual and the type of debris. The consequence of debris-induced inflammation is continued; vigilance by physicians is recommended monitoring of spinal implants using physical exams and testing of metal content and bioreactivity, as is planning for the likelihood of revision in younger individuals.

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Section: Resultsmentioning

confidence: 99%

A review of the biologic effects of spine implant debris: Fact from fiction

Hallab¹

2009

SAS Journal

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“…Our results also indicate knee replacement surgery is a common cause of sciatic neuropathy, secondary only to hip replacement surgery among all surgery subtypes. Sciatic neuropathy as a complication of knee replacement surgery has been previously reported, and possible risk factors for postoperative nerve injury may include female sex and lumbar pathology . In 1 recent report, popliteal fossa nerve block was described as an etiology for sciatic neuropathy .…”

Section: Discussionmentioning

confidence: 99%

Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy

Cherian

2018

Muscle and Nerve

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Introduction: In this study we sought to characterize etiologies and features of sciatic neuropathy unrelated to penetrating nerve trauma. Methods: This investigation was a retrospective review of 109 patients with electrodiagnostically confirmed sciatic neuropathies. Results: Hip replacement surgery represented the most common (34.9%) etiology, whereas inflammatory sciatic neuropathy was seen in 7.3%. Electrodiagnostic testing revealed an axonal neuropathy in 95.4% and a demyelinating neuropathy in 4.6%. Predominant involvement of the peroneal division was seen in 39.4% and was tibial in 5.5%. Nine of 31 (29.0%) patients who had MRI or neuromuscular ultrasound study showed abnormalities within the sciatic nerve. At the final visit, 46.4% of patients required assistance for ambulation. Young age, lack of severe initial weakness, and presence of tibial compound muscle action potential or sural sensory nerve action potential were predictors of favorable outcome. Discussion: Sciatic neuropathies are usually axonal on electrodiagnostic testing, affect preferentially the peroneal division, and are commonly associated with incomplete recovery.Muscle Nerve 59:309-314, 2019Additional supporting information may be found in the online version of this article.

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“…Synthetic conduits have been used to fill the gap between ends of broken nerve, to guide and to promote never regeneration. A variety of materials, such as collagen, [1] polytetrafluoroethene, [2] silicone, [3] polyethylene, [4] polycaprolactone, [5] polyglycolic acid, [6] and poly(lactic-co-glycolic acid), [7] have been used to fabricate the nerve conduit. Textile technology have showed promising potential in biomaterials design.…”

Section: Introductionmentioning

confidence: 99%

Manufacturing Technology and Characteristics of Nerve Conduits Made of Poly(<i>Lactic acid</i>) Braids

Lou

Chen³

et al. 2011

AMR

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The nerve system has the upmost role in coordinating the actions of an animal. It is, therefore, important to repair the damaged nerve to restore its functions. In this study, we braided poly(lactic acid) ply yarn into a tubular structure using a 16-spindle braiding machine, aiming at making a nerve conduit. The results showed that the poly(lactic acid) braid obtains the maximum tensile stress when the ratio of take-up gear and braid gear is 60/50. The extensibility of the produced braid makes it a suitable conduit for nerve regeneration.

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Acute Sciatic Nerve Palsy Caused by a Polyethylene Granuloma Arising From a Well-fixed Total Knee Arthroplasty

Cited by 5 publications

References 11 publications

A review of the biologic effects of spine implant debris: Fact from fiction

A review of the biologic effects of spine implant debris: Fact from fiction

Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy

Manufacturing Technology and Characteristics of Nerve Conduits Made of Poly(<i>Lactic acid</i>) Braids

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