Peri-articular reactions to microscopic erosion of silicone-polymer implants. Light- and scanning electron-microscopic studies with energy-dispersive x-ray analysis.
Two patients are described who underwent implantation of silicone-polymer prostheses: one for an arthroplasty of the left great toe after a bunionectomy, and another for replacement of fractured trapezoid bone of the left wrist. Each patient developed unexplained severe pain at the sites of surgery at 3 and 7 months postoperatively. On removal of the implants and adjacent tissues, there was a microscopic foreign-body reaction to amorphous material in the subsynovial connective tissue. Although both prostheses were grossly intact, scanning electron microscopy revealed multiple erosions on their surfaces. Energy-dispersive x-ray analysis of foreign material in the paraffin-embedded sections revealed a peak for silicon. These two cases indicate that clinically significant pathological reaction may occur as early as 3 months after silicone-polymer implantation and that energy-dispersive x-ray analysis of excised tissue is a useful and specific diagnostic procedure.
D000328:Adult; D003238:Connective Tissue / Q000473:pathology* / Q000648:ultrastructure; D006801:Humans; D008297:Male; D008875:Middle Aged; D011108:Polymers; D019736:Prostheses and Implants / Q000009:adverse effects*; D012828:Silicones; D014033:Toe Joint / Q000473:pathology / Q000601:surgery*; D014955:Wrist Joint / Q000473:pathology / Q000601:surgery*
D011108:Polymers; D012828:Silicones