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

Abstract

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.

Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement

“…Some studies report an increased cellular response in synovial-like membrane of periprosthetic tissue and suggest that SLIM is the best material available for histopathological analysis [50,73]. However, some studies show that there is a large variability within the sampled tissues even when the same kind of retrieved tissue is sampled [42,115,135]. Discrepancies may be even in the single sample [42].…”

Pyrroloquinoline Quinine Inhibits RANKL-Mediated Expression of NFATc1 in Part via Suppression of c-Fos in Mouse Bone Marrow Cells and Inhibits Wear Particle-Induced Osteolysis in Mice

“…Scanning electron microscopy (Hitachi, Osaka, Japan) analysis demonstrated that 90% of the UHMWPE particles were less than 9 µm in diameter, with a mean size of 1.74 µm, with diameters ranging from less than 0.05 to 11.06 µm (SD 1.43µm). The sizes of most particles are in the biologically active range compared with isolated from periprosthetic membrane [19]. UHMWPE particles were washed in 70% ethanol solution at room temperature using a rocking device to remove endotoxin, and resuspended in sterile phosphate-buffered saline (PBS) at a concentration of 100 mg/ml, and stored at 4 o C until use [20], [21].…”

Orthopedic Implant Retrieval and Failure Analysis

“…Highly cross-linked polyethylene tibial tray inserts are now available with higher wear and fatigue resistance than for conventional polyethylene [117]. However, the findings of elevated oxidation at the rim of annealed liners and wear debris in periprosthetic tissues indicate that additional research and development are necessary [118,119].…”