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PubMed2002

Rapid polyethylene failure of unicondylar tibial components sterilized with gamma irradiation in air and implanted after a long shelf life.

BACKGROUND: The mechanical toughness of polyethylene that has been sterilized by gamma irradiation in air decreases after a long shelf life. The purpose of the present study is to report the high failure rate after unicondylar knee replacements performed with polyethylene bearings that had been sterilized with gamma irradiation in air and implanted after a shelf life of < or = 4.4 years. METHODS: Between December 1997 and January 2000, seventy-five unicondylar knee replacements were performed in sixty-two patients. All patients were followed both clinically and radiographically. A revision operation was offered when the patient had pain, swelling, and radiographic evidence of rapid polyethylene wear. The effect of aging of the polyethylene during storage was evaluated by dividing the knees into three groups on the basis of shelf life and comparing them with regard to the rate of revision and the observed wear of the polyethylene. Four retrieved components were examined for the presence of oxidation. RESULTS: At a mean of eighteen months after the arthroplasty, thirty knees had been revised and seven were scheduled for revision. The rate of polyethylene wear increased as the shelf life increased. There was a significant inverse linear correlation between the shelf life of the polyethylene and the time to revision (p < 0.01, r (2) = 0.64). All retrieved components had greater-than-expected wear with pitting and delamination of the surface. Seven components had fractured, and ten had both fractured and fragmented. Analysis of four components confirmed severe oxidation of the polyethylene. CONCLUSION: The present study demonstrated early, severe wear of tibial polyethylene bearings that had been sterilized by gamma irradiation in air and stored for < or = 4.4 years. This risk can be minimized by ensuring that implants have not been sterilized with gamma irradiation in air and stored for several years.

Arthroplasty, Replacement, Knee↗

PubMed1990

The biomechanical problems of polyethylene as a bearing surface.

The metal backings of acetabular components can reduce the available polyethylene thickness, often to an alarming extent. This study indicated that the pitting and cracking of thin polyethylene surfaces have some similarities to tibial and patellar bearings and that creep-related deformation occurred more frequently in thin polyethylene components. Additionally, it appears that dimensional tolerances of the polyethylene inserts are difficult to maintain and may result in a nonuniform fit of both the femoral head into the component and the component into its own metal backing, which can lead to component separation. It is difficult to accurately measure the changes in material and mechanical properties of polyethylene over time. An additional ramification is that flaws, such as voids in the polyethylene, cannot be attributed to problems of bulk supply, fabrication, or postmanufacturing treatment. Orthopedic device manufacturers should keep samples of each lot of polyethylene used and provide components with serial numbers so that the source, composition, and properties of the original bulk material and material "as fabricated" can be documented. This would permit researchers studying revisions or postmortem samples to determine the changes in the polyethylene over time in vivo, thus improving the understanding of this crucial material. If manufacturers were to include dimensions and tolerances of the polyethylene inserts in their product literature, accurate measurements of wear of retrieved specimens may be possible.

Acetabulum↗

PubMed1989

Decrease in intestinal permeability to polyethylene glycol 1000 during development in the pig.

Changes in intestinal permeability during postnatal development in the pig were investigated by using different-sized polyethylene glycols in the Mr 766-1338 range (polyethylene glycol 1000) as permeability probes. Pigs of varying age, newborn (Oh), 36-45 h old and 22-28 days old, were gavage fed polyethylene glycol 1000 together with the macromolecular markers bovine serum albumin, ovalbumin or FITC-labelled dextran 70,000. The 4-h blood serum concentrations of the different markers were determined and taken as an estimate of their intestinal transmission. In the newborn pigs, high serum levels of polyethylene glycols were obtained, concomitant with high serum levels of bovine serum albumin and FITC-dextran. After intestinal macromolecular closure in the 36-45 h-old pigs, lower serum polyethylene glycol levels were found, especially of those with a Mr greater than 1100 Da. In the 22-28 days-old pigs, polyethylene glycol levels were reduced to one-tenth or less of those in the 36-45 h-old pigs, with the levels decreasing markedly with increasing molecular size. These results show that there is a correlation between the intestinal permeability of polyethylene glycols, especially those larger than 1100, and macromolecules in the newborn pig around intestinal closure, suggesting that such polyethylene glycols traverse the gut by the macromolecular route. During later development, further intestinal maturation results in a markedly reduced permeability to polyethylene glycol 1000.

Aging↗

PubMed1983

Radioprotection by polyethylene glycol-protein complexes in mice.

Polyethylene glycol of about 5000 D was activated with cyanuric chloride, and the activated compound was complexed to each of three proteins. Polyethylene glycol-superoxide dismutase and polyethylene glycol-catalase were each radioprotectants when administered prophylactically to female B6CBF1 mice before irradiation. The dose reduction factor for these mice was 1.2 when 5000 units of polyethylene glycol-catalase was administered before 60Co irradiation. Female B6CBF1 mice administered prophylactic intravenous injections of catalase, polyethylene glycol-albumin, or heat-denatured polyethylene glycol-catalase had survival rates similar to phosphate-buffered saline-injected control mice following 60Co irradiation. Polyethylene glycol-superoxide dismutase and polyethylene glycol-catalase have radioprotective activity in B6CBF1 mice, which appears to depend in part on enzymatic activities of the complex. However, no radioprotective effect was observed in male C57BL/6 mice injected with each polyethylene glycol-protein complex at either 3 or 24 hr before irradiation. The mechanism for radioprotection by these complexes may depend in part on other factors.

Animals↗

PubMed1995

Measurement of polyethylene wear in metal-backed acetabular cups. II. Clinical application.

The new 3-dimensional technique was applied to the radiographs of 141 patients who had received Porous Coated Anatomic total hip prostheses. Values were obtained for the position of the acetabular cup, the 3-dimensional distance and direction of femoral head displacement, and the minimum volume of polyethylene debris produced. Mean age of the patients at the time of replacement was 61 years old; mean followup was 5.6 years (range, 4-7.2 years). Change in the position of the femoral head between initial and long-term followup films was assumed to represent polyethylene wear, and formulas were used to calculate the minimal volume of polyethylene debris produced. The overall rate of 3-dimensional femoral head displacement was 0.264 mm per year, almost twice that usually quoted in the current literature for 2-dimensional linear wear. A significant contribution to this value was made by anterior and posterior displacement. Two-dimensional femoral head displacement (measured in the plane of anteroposterior radiographs) on the same patients was 0.149 mm per year. The mean minimum volume of polyethylene debris produced after 5.6 years was 0.448 cm3 (range, 0.00-2.83 cm3), giving a mean rate of 0.079 cm3 polyethylene debris produced each year. Thirteen patients in this series had radiologic osteolysis and a significantly greater femoral head displacement and polyethylene volumetric wear than those with no osteolysis. Patients with a 32-mm femoral head diameter and a polyethylene linear < 1 cm thick had a significantly greater amount of polyethylene wear. This series gives previously unavailable data on 3-dimensional femoral head displacement and is the first report that correlates the minimum volume of polyethylene wear produced with radiologic osteolysis.

Acetabulum↗

PubMed1995

Polyethylene wear debris in modular acetabular prostheses.

The longevity of total hip arthroplasty has brought forth the recognition of aseptic loosening of prosthetic components as the leading cause of implant failure. Modularity of implants, although a significant improvement in versatility, may increase debris formation, a recognized cause of implant failure. This study was designed to measure the relative motion, and to assess the polyethylene wear debris production at the interface between the metal acetabular shell and the back side of the polyethylene liner, in modular hip prostheses. Five models from 4 manufacturers with different locking mechanisms and acetabular shell surface treatments were tested under long-term simultaneous sinusoidal and static loading (10(7) cycles at 3 Hz with +/- 2.5 Nmeter and 220 N static load). Results showed that there were marked differences in the security of the acetabular shell and polyethylene liner locking mechanism, wear pattern, damage sites, and amount of polyethylene debris on the acetabular shell and polyethylene liner surfaces. The range of polyethylene liner motion observed among the 5 models during 1 cycle of testing varied from an average of 0.96 degrees to movement too small to be detected by the test machines. Image and scanning electron microscopy analysis showed different wear patterns and a wide range in the average polyethylene liner surface wear area (0.26 cm2-4.61 cm2). In general, a stable locking mechanism and a smooth acetabular shell surface are essential in minimizing polyethylene liner wear and polyethylene debris production.

Biomechanical Phenomena↗

PubMed1998

Role of polyethylene oxidation and consolidation defects in cup performance.

Quality factors such as particle consolidation and oxidation have been claimed to impair the performance of ultrahigh molecular weight polyethylene implants, but no definite data estimate their real effect. To assess the influence of these quality determinants in wear, wear rate, and time in service at a single, well proven design, the percentage area of polyethylene sections occupied by nonconsolidated polyethylene particles, the presence of a white band, and the amount of polyethylene oxidation (through density curves) were evaluated in 92 retrieved Charnley acetabular components with available clinical data. The average percentage area of nonconsolidated polyethylene particles in cup sections was 3.1%. There were 11 cups showing a subsurface white band. The authors observed an average density in the deep polyethylene of 0.9420 g/cc after an average in vivo use of 9.8 years (range, 0.08-20.3 years). Banded cups showed significantly higher subsurface densities. When studying the relationship among clinical and material factors with performance variables, wear measurements (obtained through radiographic methods and direct measurements of polyethylene thickness in the collected implants) correlated with age at implantation, activity, and time in service. Weight was a determinant of the wear rate. None of the studied polyethylene quality factors showed a definite association with wear performance or time to failure in this series. Implant survivorship was not significantly impaired in the 22.225-mm Charnley low friction replacement by a subsurface white band or by a higher area occupied by nonconsolidated particles. Fewer nonconsolidated particles were not associated with longer survivorship. This design proved tolerance to polyethylene quality variations, in the signaled ranges, without a significant effect in the system performance.

Arthroplasty, Replacement, Hip↗

PubMed1999

Development of an extremely wear-resistant ultra high molecular weight polyethylene for total hip replacements.

Osteolysis induced by ultra high molecular weight polyethylene wear debris is one of the primary factors limiting the lifespan of total hip replacements. Crosslinking polyethylene is known to improve its wear resistance in certain industrial applications, and crosslinked polyethylene acetabular cups have shown improved wear resistance in two clinical studies. In the present study, crosslinked polyethylene cups were produced by two methods. Chemically crosslinked cups were produced by mixing a peroxide with ultra high molecular weight polyethylene powder and then molding the cups directly to shape. Radiation-crosslinked cups were produced by exposing conventional extruded ultra high molecular weight polyethylene bar stock to gamma radiation at various doses from 3.3 to 100 Mrad (1 Mrad = 10 kGy), remelting the bars to extinguish residual free radicals (i.e., to minimize long-term oxidation), and then machining the cups by conventional techniques. In hip-joint simulator tests lasting as long as 5 million cycles, both types of cross-linked cups exhibited dramatically improved resistance to wear. Artificial aging of the cups by heating for 30 days in air at 80 degrees C induced oxidation of the chemically crosslinked cups. However, a chemically crosslinked cup that was aged 2.7 years at room temperature had very little oxidation. Thus, whether substantial oxidation of chemically crosslinked polyethylene would occur at body temperature remains unclear. The radiation-crosslinked remelted cups exhibited excellent resistance to oxidation. Because crosslinking can reduce the ultimate tensile strength, fatigue strength, and elongation to failure of ultra high molecular weight polyethylene, the optimal crosslinking dose provides a balance between these physical properties and the wear resistance of the implant and might substantially reduce the incidence of wear-induced osteolysis with total hip replacements.

Arthroplasty, Replacement, Hip↗

PubMed2006

Wear and toughness of crosslinked polyethylene for total knee replacements: a study using a simulator and small-punch testing.

Severe loading and complex kinematics in total knee replacement make wear performance and toughness of the polyethylene in tibial inserts important. We investigated wear of crosslinked polyethylene using a knee simulator and measured toughness using small-punch testing. GUR1050 rods were gamma-irradiated in air at doses from 0 to 200 kGy, annealed in nitrogen, and machined into tibial inserts. The simulator was run to 4 million cycles, and wear rates determined from weight loss. Wear rate decreased by 54, 78, and 95% as radiation dose increased from 50 to 75 to 100 kGy, respectively. At every dose, toughness was significantly less after simulator testing, but the difference between control and wear-tested polyethylene, considered to be due to fatigue damage accumulation, was smallest at 50 kGy. The simulator-tested polyethylene that received 35 to 75 kGy had slightly higher toughness than equivalent material that received no irradiation. However, the toughness of simulator-tested polyethylene that received 150 and 200 kGy was lower than that of the simulator-tested polyethylene that received no irradiation. Our results suggest that an optimal irradiation dose may exist for crosslinked polyethylene for use in TKR and that the optimum dose would be less than the 100 kGy or more that are used in some current crosslinked polyethylene for hip replacement.

Biomechanical Phenomena↗

PubMed1984

The rate of polymerization of rabbit skeletal muscle actin is enhanced by polyethylene glycol.

The effect of polyethylene glycol on the kinetics of actin polymerization was determined by monitoring the enhancement in the fluorescence of pyrenyl-labelled actin. The polymerization of actin at 15 mM KCl was in addition followed by viscometry and light scattering. All three methods showed that the overall rate of polymerization of actin increased 3-4-fold when the concentration of polyethylene glycol was increased from 0 to 6% (ww-1). A further increase in polyethylene glycol concentration to 10% (ww-1) caused a relatively small contribution to the increase in the rate of polymerization. The enhancement of the overall rate of polymerization by polyethylene glycol was also reflected in a significant decrease in the lag time observed when the time course of polymerization was followed by viscometry and light scattering. The steady-state value of fluorescence enhancement and critical concentration of actin were also influenced by polyethylene glycol and the results showed that the extent of polymerization was increased by an increase in the concentration of polyethylene glycol in solution. The effect of polyethylene glycol on both rate and extent of polymerization persisted at physiological salt concentration (150 mM KCl, 2 mM MgCl2). Since the rate of elongation was affected only to a small extent by polyethylene glycol, we propose that its main effect is on nucleation.

Actins↗

PubMed1980

Effects of polyethylene glycol on reverse transcriptase and other polymerase activities.

Polyethylene glycol enhances reverse transcription, augmenting both the rate and duration of polymerization. The effective mean molecular weight of polyethylene glycol is 6000 and the optimal concentration is 12% (w/w). Polyethylene glycol is effective on the reverse transcriptase reaction of all ten type B, C, and D viruses tested under a variety of exogenous, endogenous, and reconstitution assay systems, including the highly efficient conditions involving calf thymus DNA oligonucleotide primers. By three methods of synthesis, polyethylene glycol increased the yields of complementary [3H]DNA by a factor of 1.8--6.5. Polyethylene glycol does not alter the divalent cation requirements of the specificities of the enzyme. Complementary [3H]DNAs made in the presence of polyethylene glycol are indistinguishable in terms of size and sequence complementarity from those made in the absence of the polymer. The stimulatory effect was partly due to the ability of polyethylene glycol to stabilize reverse transcriptase. Preliminary tests indicate that polyethylene glycol also stimulates other nucleotide polymerases, such as the DNA-dependent DNA and RNA polymerases of Escherichia coli and the terminal transferase of calf thymus.

Escherichia coli↗

PubMed2005

Polyethylene and titanium particles induce osteolysis by similar, lymphocyte-independent, mechanisms.

Periprosthetic osteolysis is a major clinical problem that limits the long-term survival of total joint arthroplasties. Osteolysis is induced by implant-derived wear particles, primarily from the polyethylene bearing surfaces. This study examined two hypotheses. First, that similar mechanisms are responsible for osteolysis induced by polyethylene and titanium particles. Second, that lymphocytes do not play a major role in particle-induced osteolysis. To test these hypotheses, we used the murine calvarial model that we have previously used to examine titanium-induced osteolysis. Polyethylene particles rapidly induced osteolysis in the murine calvaria 5-7 days after implantation. The polyethylene-induced osteolysis was associated with large numbers of osteoclasts as well as the formation of a thick periosteal fibrous tissue layer with numerous macrophages containing phagocytosed polyethylene particles. Polyethylene-induced osteolysis was rapidly repaired and was undetectable by day 21 after implantation. Lymphocytes were noted in the fibrous layer of wild-type mice. However, the amount of osteolysis and cytokine production induced by polyethylene particles was not substantially affected by the lack of lymphocytes in Pfp/Rag2 double knock out mice. All of these findings are similar to our observations of osteolysis induced by titanium particles. These results provide strong support for both of our hypotheses: that similar mechanisms are responsible for osteolysis induced by polyethylene and titanium particles and that lymphocytes do not play a major role in particle-induced osteolysis.

Animals↗

PubMed2001

Influence of particle size in the effect of polyethylene on human osteoblastic cells.

The influence of two different sizes of polyethylene particles (< 30 and 20-200 microm) on osteoblastic function has been studied in primary human bone cell cultures. Cells were obtained from trabecular bone fragments of patients undergoing knee reconstructive surgery. On reaching confluency, cells were subcultured in three flasks: < 30 microm polyethylene particles were added to the first flask, 20-200 microm particles to the second flask and none to the third flask, which was the control. The resulting subcultures were incubated until confluence. Osteoblastic function was evaluated by assaying the secretion of osteocalcin, alkaline phosphatase, and C-terminal type I procollagen (PICP), with or without 1.25(OH)2D3 stimulation in the cell-conditioned medium. Adding < 30 microm polyethylene particles to these osteoblastic cell cultures increased the levels of osteocalcin secreted after 1,25(OH)2D3 stimulation. Treating stimulated or basal osteoblastic cultures with either polyethylene particle size did not affect alkaline phosphatase secretion. However, the addition of <30 microm polyethylene particles decreased PICP levels in the basal and stimulated cultures. A parallel series of osteoblastic cultures was treated with < 30 microm polyethylene particles and stimulated or not with 1,25(OH)2D3 to determine the effect on osteocalcin mRNA expression using RT-PCR amplification. Polyethylene particle-treated cultures had higher osteocalcin mRNA expression regardless of whether they had been stimulated with 1,25(OH)2D3 or not. We conclude that particle size affects the influence of polyethylene on osteoblastic function markers. Particles with a diameter of less than 30 microm increase osteocalcin expression and secretion.

Alkaline Phosphatase↗

PubMed2002

Effects of polyethylene and alpha-alumina particles on IL-6 expression and secretion in primary cultures of human osteoblastic cells.

The effect of two biomaterials, polyethylene and alpha-alumina, on interleukin-6 (IL-6) secretion and expression has been studied in human osteoblasts in primary culture. Human osteoblastic cells were derived from fresh trabecular bone explants removed during total knee arthroplasty. On reaching confluence, cells were subcultured in 6 well plates; the resulting subcultures were incubated until confluence and polyethylene or alpha-alumina particles were added to some while the rest were left as controls. The IL-6 mRNA levels were assessed by reverse transcription (RT) followed by polymerase chain reaction (PCR). IL-6 secretion was measured in the conditioned medium. The IL-6 expression was higher in the presence of both biomaterials. Maximum expression occurred in response to a dose of 50 mg particles well with both biomaterials and was greater after polyethylene particle addition than after alpha-alumina particle addition at this dose. The maximum IL-6 secretion elicited by alpha-alumina was produced at 10 mg particles well while maximum response with polyethylene required 50 mg well. At a dose of 10 mg/well, alpha-alumina particles induced more secretion than 10 mg of polyethylene particles. Nevertheless, at a dose of 50 mg/well maximum secretion was produced with polyethylene particles. In conclusion and in our experimental conditions, polyethylene as well as alpha-alumina increased both the expression and the secretion of IL-6 in human osteoblastic cells in primary culture and stimulation from polyethylene appears stronger than that from alpha-alumina at the same dose.

Aluminum Oxide↗

PubMedDate not supplied

Effect of polyethylene particles on human osteoblastic cell growth.

In this study, we have analyzed the direct effect of ultrahigh molecular weight polyethylene (polyethylene) on the osteoblastic cell growth in primary cultures. The cells were cultured from human bone samples obtained during reconstructive joint surgery. When cell cultures reached confluence (4-6 weeks) they were separated into three subcultures. One subculture was without particle addition (plain culture). In the other two subcultures, polyethylene or alumina was added. Two different sizes of particles were used, <80 and <160 microm. The subcultures were incubated until confluence. Proliferation of each subculture was measured by cell counts after 3, 6, 9 and 13 days, and the area under the curve (AUC) was calculated. Polyethylene particles of <160 microm induced a decrease in growth, whereas alumina of the same size did not. Polyethylene and alumina particles of <80 microm induced an inhibition in the osteoblastic cell growth; <80 microm polyethylene induced a higher inhibition than alumina of the same particle size. In conclusion, we have observed a direct effect of polyethylene on osteoblastic cell growth. This study shows that polyethylene may decrease the growth rate of human osteoblastic cells in primary cultures. Smaller particles produce a more marked reduction.

Biocompatible Materials↗

PubMed2002

The effect of malalignment on stresses in polyethylene component of total knee prostheses--a finite element analysis.

OBJECTIVE: To investigate the effects of malalignment on stresses in tibial polyethylene component of total knee prostheses. DESIGN: A three-dimensional finite element analysis was used to calculate the contact stress and von Mises stress in the tibial polyethylene component subjected to a compressive load, and the malalignment situations were simulated. BACKGROUND: Many biomechanical studies to investigate the stresses in tibial polyethylene component were assumed at the ideal contact alignment. The effect of malalignment on stresses in tibial polyethylene component was not investigated extensively. METHODS: Three-dimensional finite element models of the tibiofemoral joint of knee prostheses for three different designs were constructed. Three malalignment conditions including the medial translation (0.25, 0.5 and 1.0 mm), internal rotation (1 degree, 3 degree and 5 degree), and varus tilt (1 degree, 3 degree and 5 degree) of the femoral component relative to the tibial component were simulated. A compression load of 3000 N was applied to the tibiofemoral joint at 0 degree of flexion. The maximum contact stress and von Mises stress in the tibial component were compared to investigate the effects of malalignment. RESULTS: In comparing with the neutral position, the greatest increase of maximum contact stress were 67.6%, 14.3% and 145.9% and the greatest increase of maximum von Mises stress were 92.5%, 22.7% and 120.6% in maltranslation, internal rotation and varus tilt simulations, respectively. CONCLUSION: The greatest increase of contact stress and von Mises stress was occurred in the high conformity flat-on-flat design of knee prosthesis under the severest malalignment condition. The high conformity curve-on-curve design of knee prosthesis has the minimal risk of polyethylene wear under the malalignment conditions. RELEVANCE: This study revealed the importance of malalignment effect on stresses in tibial polyethylene component. Polyethylene wear in surface replacement total knees will be minimal when a high conformity curve-on-curve knee design is used and the rotational line between the femoral and tibial components has the least effect on polyethylene wear but varus/valgus malalignment, even with the best designed prosthesis will still accelerate wear.

Bone Malalignment↗

PubMed2004

High-molecular-weight polyethylene glycol prevents lethal sepsis due to intestinal Pseudomonas aeruginosa.

BACKGROUND & AIMS: During stress, erosion of protective intestinal mucus occurs in association with adherence to and disruption of the intestinal epithelial barrier by invading opportunistic microbial pathogens. The aims of this study were to test the ability of a high-molecular-weight polyethylene glycol compound, polyethylene glycol 15-20, to protect the intestinal epithelium against microbial invasion during stress. METHODS: The ability of polyethylene glycol 15-20 to protect the intestinal epithelium against the opportunistic pathogen Pseudomonas aeruginosa was tested in cultured Caco-2 cells. Bacterial virulence gene expression, bacterial adherence, and transepithelial electrical resistance were examined in response to apical inoculation of P. aeruginosa onto Caco-2 cells. Complementary in vivo studies were performed in a murine model of lethal sepsis due to intestinal P. aeruginosa in which surgical stress (30% hepatectomy) was combined with direct inoculation of P. aeruginosa into the cecum. RESULTS: High-molecular-weight polyethylene glycol (polyethylene glycol 15-20) conferred complete protection against the barrier-dysregulating effects of P. aeruginosa in Caco-2 cells. Intestinal application of polyethylene glycol 15-20 in stressed mice protected against the lethal effects of intestinal P. aeruginosa. Mechanisms of this effect seem to involve the ability of polyethylene glycol 15-20 to distance P. aeruginosa from the intestinal epithelium and render it completely insensate to key environmental stimuli that activate its virulence. CONCLUSIONS: High-molecular-weight polyethylene glycol has the potential to function as a surrogate mucin within the intestinal tract of a stressed host by inhibiting key interactive events between colonizing microbes and their epithelial cell targets.

Animals↗

PubMedDate not supplied

[Polyethylene content and cell size of foreign body giant cells in aseptic hip prosthesis loosening--a histomorphometric study].

INTRODUCTION: In aseptic loosening of cementless hip arthroplasty polyethylene particles are phagocytized by macrophages and foreign-body giant cells. This initiates an osteolytic cascade. In this study, the authors investigated if there are correlations between the size of foreign-body giant cells and the polyethylene loading and number of intracellular particles as determined by light microscopy. MATERIAL AND METHOD: Histological specimens were processed from tissues retrieved during revision surgery of 7 cases of cementless hip arthroplasty which had become aseptically loose. The specimens were analyzed by histolomorphology and histomorphometry. The cell size, polyethylene loading and intracellular particle number of 111 foreign-body giant cells were determined. A regression analysis was performed to investigate if there was a correlation between these variables. RESULTS: The mean cell size was 1417 +/- 487 micron 2, the mean polyethylene loading was 49 +/- 42 micron 2 and the mean intracellular particle number was 10.4 +/- 5.4. The cell size correlated with both the intracellular particle number (r = 0.25) and the polyethylene loading (r = 0.39). CONCLUSIONS: In the cellular reaction to polyethylene particles in aseptic loosening of cementless total hip arthroplasty, the size of foreign-body giant cells correlates with intracellular polyethylene loading and intracellular polyethylene particle number as determined by light microscopy. The presence of large foreign body giant cells might be associated with a high particle load of the tissue and a high osteolytic activity.

Aged↗