Retrieval analyses of highly cross-linked polyethylene acetabular liners four and five years after implantation

Abstract

Two Durasul highly crosslinked polyethylene liners were exchanged during revision surgery four and five years after implantation, respectively. The retrieved liners were evaluated macroscopically and surface analysis was performed using optical and electron microscopy. A sample of each liner was used to determine the oxidation of the material by Fourier transform infrared spectroscopy. Samples of the capsule were examined histologically. The annual wear rate was found to be 0.010 and 0.015 mm/year, respectively. Surface analysis showed very little loss of material caused by wear. Histological evaluation revealed a continuous neosynovial lining with single multinucleated foreign-body giant cells. Our findings showed no unexpected patterns of wear on the articulating surfaces up to five years after implantation and no obvious failure of material.

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

“…In agreement with prior immunohistochemical [3,5,12,28,36,40,41] or histologic [42,59] studies, the predominant cells in both cohorts were macrophages and T cells. The contribution of neutrophils was negligible, and even the largest neutrophil infiltration (8.6/mm 2 ; Table 2) represented only a fraction of what would be considered evidence of subclinical infection [4,7,17,56].…”

“…Similar to a previous study of two patient tissues from revised HXLPE liners, we found macrophages, a few lymphocytes, and limited amounts of UHMWPE wear debris [42]. However, immunohistochemistry was not done in that study [42] to quantify individual cell types or evaluate colocalization of the inflammatory response with wear debris.…”

“…Using this approach, we found macrophage and T cell responses were moderately correlated for each of the nine patients and combined regions. The limited number of wear particles found in their study [42] and in ours may represent the greater potential for smaller particles to migrate away from the implant site. Alternatively, or in addition, nanometer-sized UHMWPE particles (\ 0.5 lm) may be present and undetected as even a small wear volume would generate large numbers of predominantly submicron-sized particles [37,38,64].…”

“…However, immunohistochemistry was not done in that study [42] to quantify individual cell types or evaluate colocalization of the inflammatory response with wear debris. Using this approach, we found macrophage and T cell responses were moderately correlated for each of the nine patients and combined regions.…”

Highly cross-linked polyethylene acetabular liners retrieved four to five years after revision surgery: A report of two cases

“…The advantage of XLPE is an apparent reduction of wear rate versus conventional polyethylene (Beksac et al, 2009 (Beksac et al, 2009;McCalden et al, 2009;Bitsch et al, 2008;Engh et al, 2006;Dorr et al, 2005). To our knowledge, only a single retrieval analysis of one type of XLPE liner implanted for greater than four years exists in literature (Knahr et al, 2007). That study reports on two XLPE liners implanted during primary 1751-6161/$ -see front matter c 2010 Elsevier Ltd. All rights reserved.…”