Histological techniques for the study of the biomaterial‐tissue interface of total joint replacements — a modification for the preservation of bone cement

Fornasier, Victor; Sanders, G.S.; Goodman, Stuart B.

doi:10.1002/jab.770030110

Cited by 6 publications

(1 citation statement)

References 10 publications

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“…In addition, Fornasier et al described techniques for the study of the implant interface. 16,17 However, none of these protocols describe methods of patient recruitment or specimen retrieval. A report of an earlier implant retrieval and analysis conference noted the interest of the Hip Society in developing a standard retrieval kit, similar to that described here.…”

Section: Discussionmentioning

confidence: 99%

Postmortem retrieval of total joint replacement components

Jacobs

Patterson

Skipor

et al. 1999

J. Biomed. Mater. Res.

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Improved understanding of the clinical outcomes of orthopedic implants requires the study of implants at the end of their service life. Previous studies focused on the retrieval of so-called failed implants during surgical revision. Interest is now moving to the study of successful implants, which are those still in place at the patient's death. A procedure was developed for recruitment of implant patients and their families and for safe and effective device and tissue retrieval after death. More than 50 retrievals were performed to support various research efforts.

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Section: Discussionmentioning

confidence: 99%

Postmortem retrieval of total joint replacement components

Jacobs

Patterson

Skipor

et al. 1999

J. Biomed. Mater. Res.

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Immunohistochemical evaluation of interface membranes from failed cemented and uncemented acetabular components

Jones

Frondoza

Hungerford

1999

J. Biomed. Mater. Res.

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Aseptic loosening of acetabular components is a primary factor compromising the long-term outcome of cemented and cementless total hip replacement. It is unknown whether the pathogenesis of the loosening process is identical for both types of fixation. The specific aim of this study was to determine whether there is a difference in the cellular and cytokine profiles of interface membranes removed from between the implant and the host bone from failed cemented (n = 5) and failed cementless acetabulae (n = 5). Routine histology and immunohistochemical evaluations were completed on each tissue specimen. The monoclonal antibodies used included those specific for cell types (macrophages, fibroblasts, T lymphocytes) and for cytokines (IL-1beta, IL-6, TNF-alpha). The patients were all revised for loosening. The time to revision was significantly longer for the cemented group (16.6 yr; 13-21 range) than for the cementless group (8.9 yr; 4-13 range). In all cases, slides from each group stained positively for each of the cell types and cytokines evaluated. Immunohistochemical analyses indicated a predominance of macrophages and ubiquitous staining for the cytokines IL-1beta and TNF-alpha within the membranes of both patient groups. The intensities of cytokine staining were similar for both patient groups. More regions of fibroblastic connective tissue were observed surrounding failed cementless components as compared to those of the cemented group. The clinical ramification of our findings is that, despite differences in the cellular composition of the periprosthetic membranes, the membranes from failed cemented and cementless implants contain cytokines, which have been shown to be capable of modulating the inflammatory response. These inflammatory mediators are likely to play a significant role in the development of osteolysis and prosthetic loosening.

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Migration of polyethylene wear debris in hip arthroplasties: A canine model

Kraemer

Maistrelli

Fornasier

et al. 1995

J of Applied Biomaterials

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The distal migration of polyethylene wear debris appears to be a major cause of loosening and osteolysis of cementless total hip arthroplasties. The use of modern cementing techniques, circumferential porous or hydroxyapatite (HA) coating has been advocated as a means of preventing access of the particles to the bone-implant interface. The purpose of this study was to compare the ability of different methods of implant fixation to prevent wear debris migration. Three each of smooth, porous-coated, HA-coated, and cemented hemiarthroplasties were implanted in the right hip of 12 dogs. Polyethylene particles were injected into the hip once a month for 4 months and then the femurs were sectioned. The percentage bone ingrowth was 8% for the smooth, 38% for the porous, and 83% for the HA-coated sections. Infiltration of the interface membrane by histiocytes containing polyethylene particles, and endosteal scalloping or osteolysis were found on all sections of the smooth prostheses. No particles or osteolysis were found on any sections of the other three types of prostheses. Capsular and lymph node sections from all dogs revealed histiocytic infiltration with numerous polyethylene particles present. It is concluded that the use of cement, porous, or HA coating prevents or delays access of the polyethylene wear debris to the bone-implant interface. No one of these methods of fixation proved more advantageous in the 5-month limit of this study.

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Histological techniques for the study of the biomaterial‐tissue interface of total joint replacements — a modification for the preservation of bone cement

Cited by 6 publications

References 10 publications

Postmortem retrieval of total joint replacement components

Postmortem retrieval of total joint replacement components

Immunohistochemical evaluation of interface membranes from failed cemented and uncemented acetabular components

Migration of polyethylene wear debris in hip arthroplasties: A canine model

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