Dissemination of Wear Particles to the Liver, Spleen, and Abdominal Lymph Nodes of Patients with Hip or Knee Replacement*

Urban, Robert M.; Jacobs, Joshua J.; Tomlinson, Michael J.; Gavrilovic, John; Black, Jonathan; Péoc’h, Michel

doi:10.2106/00004623-200004000-00002

Cited by 676 publications

(485 citation statements)

References 61 publications

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“…The local and systemic effects of these particles are not completely clear. Lymphatic dissemination of metallic wear particles has been observed [9], and there are numerous reports of increased serum levels of metal ions after metal-on-metal hip arthroplasty [10]. As reported in the literature, measurements of serum levels of metals might have been useful for initial diagnosis [11].…”

Section: Discussionmentioning

confidence: 99%

“…As reported in the literature, measurements of serum levels of metals might have been useful for initial diagnosis [11]. Apparently, there is no increase in the incidence of malignancies in patients exposed to metal particles [12], but in patients with metal-on-metal bearings, hypersensitivity to metals is higher than in normal population, especially in those with failed implants [9,13]. Massive wear and extensive metallosis must be avoided.…”

Section: Discussionmentioning

confidence: 99%

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Catastrophic Wear in a Metal-On-Ceramic Total Hip Arthroplasty

Valentí

Rı́o

Amillo

2007

The Journal of Arthroplasty

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A 51-year-old woman came to our clinic 6 months after a right total hip arthroplasty. She had noticed a slowly growing mass in the proximal thigh and referred progressive pain in the right groin. Plain radiography revealed premature acetabular cup aseptic loosening, and in the computed tomography study, a 14-cm-diameter mass was observed. Revision surgery was performed, showing a metal-on-ceramic bearing surface. The histologic analysis of surrounding tissues was reported as massive metallosis. Although occasionally chosen for primary or revision hip arthroplasty, there is little information available about the in vivo wear behavior of this combination. This important fact should be taken into account before considering such a surface alternative.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Catastrophic Wear in a Metal-On-Ceramic Total Hip Arthroplasty

Valentí

Rı́o

Amillo

2007

The Journal of Arthroplasty

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“…Suspicions about a possible causal association between joint replacements and cancer are largely concerned with the effects of metal implants (Sunderman, 1989;Jacobs et al, 1998;Urban et al, 2000). It has been suspected that minute, free-roaming particles, resulting from wear and tear, could have carcinogenic effects and, in particular, might increase the risk of lymphoma, leukaemia and cancer of the urinary tract.…”

Section: Discussionmentioning

confidence: 99%

“…There has been long-standing interest in whether prolonged contact between body tissue and plastic and metal prostheses does increase the risk of cancer. Corrosion and normal wear and tear of prostheses are known to liberate polyethylene and metallic particles (Sunderman, 1989;Jacobs et al, 1998;Urban et al, 2000). If these have any pathological effect, it is thought that the corrosion products are most likely to affect the haematopoietic, lymphatic and urinary systems.…”

mentioning

confidence: 99%

Cancer following hip and knee arthroplasty: record linkage study

et al. 2005

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Concerns have been raised that degradation of implants used in hip and knee arthroplasty may lead to an increased risk of some cancers, particularly those of the haematopoietic, lymphatic and urinary systems. We used linked statistical records of hospital admissions and deaths to compare cancer rates in cohorts of people who had undergone hip or knee arthroplasty with a comparison cohort. We did not find an elevated risk for cancer, overall, in either the hip or knee cohort or in both combined (rate ratio for both combined 0.99; 95% confidence intervals 0.95 -1.02), or for haematopoietic, lymphatic or urinary system cancers. There was also no elevation in risk of cancer more than 10 years after arthroplasty. Our findings add to the evidence that arthroplasty is safe in respect of cancer risk.

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“…In agreement with other reports, we observed distinct regional and patient differences in the immune cell responses [8,28,36,40] and notably a corresponding heterogeneity in UHMWPE particle number. The accumulation of UHMWPE wear debris in periprosthetic tissue may depend on several factors, other than their rate of production, including tissue morphology, particle size, and particle migration [6,8,15,75]. In general, wear debris was observed predominantly in periprosthetic tissues removed from the bone-implant interface.…”

Section: Discussionmentioning

confidence: 99%

Do Tissues From THA Revision of Highly Crosslinked UHMWPE Liners Contain Wear Debris and Associated Inflammation?

Baxter

Freeman

Kurtz

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Polyethylene wear debris is a major contributor to inflammation and the development of implant loosening, a leading cause of THA revisions. To reduce wear debris, highly crosslinked ultrahigh-molecular-weight polyethylene (UHMWPE) was introduced to improve wear properties of bearing surfaces. As highly crosslinked UHMWPE revision tissues are only now becoming available, it is possible to examine the presence and association of wear debris with inflammation in early implant loosening. Questions/purposes We asked: (1) Does the presence of UHMWPE wear debris in THA revision tissues correlate with innate and/or adaptive immune cell numbers? (2) Does the immune cell response differ between conventional and highly crosslinked UHMWPE cohorts?Methods We collected tissue samples from revision surgery of nine conventional and nine highly crosslinked UHMWPE liners. Polarized light microscopy was used to determine 0.5-to 2-lm UHMWPE particle number/mm 2 , and immunohistochemistry was performed to determine macrophage, T cell, and neutrophil number/mm 2 . Results For the conventional cohort, correlations were observed between wear debris and the magnitude of individual patient macrophage (q = 0.70) and T cell responses (q = 0.71) and between numbers of macrophages and T cells (q = 0.77) in periprosthetic tissues. In comparison, the highly crosslinked UHMWPE cohort showed a correlation between wear debris and the magnitude of macrophage responses (q = 0.57) and between macrophage and T cell numbers (q = 0.68). Although macrophages and T cells were present in both cohorts, the highly crosslinked UHMWPE cohort had lower numbers, which may be associated with shorter implantation times. Conclusions The presence of wear debris and inflammation in highly crosslinked UHMWPE revision tissues may contribute to early implant loosening.

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Dissemination of Wear Particles to the Liver, Spleen, and Abdominal Lymph Nodes of Patients with Hip or Knee Replacement*

Cited by 676 publications

References 61 publications

Catastrophic Wear in a Metal-On-Ceramic Total Hip Arthroplasty

Catastrophic Wear in a Metal-On-Ceramic Total Hip Arthroplasty

Cancer following hip and knee arthroplasty: record linkage study

Do Tissues From THA Revision of Highly Crosslinked UHMWPE Liners Contain Wear Debris and Associated Inflammation?

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