Foreign-Body Reaction and the Course of Osteolysis After Polyglycolide Implants for Fracture Fixation

Abstract

Foreign-body reaction to polyglycolide (PGA) implants has been described in man. Many animal experiments have verified the mechanical properties of fixation devices made from PGA, but a significant foreign-body reaction has not been described. We studied the effect of PGA rods in 12 sheep with standardized osteochondral fractures of the medial femoral condyle fixed with uncoloured, self-reinforced PGA rods (Biofix). Radiographs were taken at intervals ranging from two weeks to two years, and the sheep were killed at intervals ranging from six to 24 months. All knees were examined histologically.Eleven of the 12 fractures healed radiologically and histologically. Moderate to severe osteolysis was seen at four to six weeks with maximum changes at 12 weeks in ten animals. Six knees showed fistula-like connections between the implant site and the joint space. Three developed synovitis, one with inflammatory changes involving the whole cartilage and one with destruction of the medial condyle.Although in our study osteochondral fractures fixed with PGA rods healed reliably, there were frequent, significant foreign-body reactions. Caution is needed when considering the use of PGA fixation devices in vulnerable regions such as the knee.

Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

“…Foreign-body reactions can be provoked with implant volumes that exceed the capacity of the surrounding soft tissues [32]. Recent recommendations suggest using the minimum possible implant size to reduce the amount of breakdown products [33].…”

Osteoarthritis of the ankle after foreign-body reaction to absorbable pins and screws

“…Acute synovitis of the knee has been described in three patients after fixation of osteochondral fragments with PGA pins, 5,6 but there was no long-term follow-up. The association between osteolytic changes and foreign-body tissue responses to PGA has been well documented in experimental 20,21 and clinical studies, 8,10,11,22 but the natural history of such lesions is not clear. We have confirmed in our study that there is usually total regression of the osteolysis within three years.…”

Recent Advances in Biodegradable Metals for Medical Sutures: A Critical Review

“…[96][97][98] Studies have furthermore shown that osteolysis and sterile fi stulae are common symptoms within 0.5 to 4 years after implantation. [93][94][95][99][100][101][102] Additionally, polymers, especially PLLA, cause a signifi cant swelling of soft tissue in a post-surgery period from 2.5 to 6 years. [ 96 ] Studies also identify encapsulated debris as a result of the polymeric degradation process.…”