title: Analysis of lymph nodes for polyethylene particles in patients who have had a primary joint replacement.
abstract: Polarized light microscopy has been used for more than forty years to identify polyethylene particles in histological specimens; however, few investigators have assessed the specificity of this technique. We examined specimens from dissected lymph nodes for the presence of strongly birefringent particles resembling polyethylene. Twenty-seven patients had dissection of lymph nodes after a total joint replacement (Group 1), and a control group of eighteen patients had dissection of lymph nodes before a total joint replacement (Group 2). Specimens from both groups of lymph nodes were examined under plain and polarized light. The presence of strongly birefringent particulate debris was graded from 0 to 4. Twenty-one (78 per cent) of the twenty-seven patients in Group 1 and eight of the eighteen patients in Group 2 had strongly birefringent particles in the lymph nodes. Our results demonstrate that, in the assessment of the systemic dissemination of polyethylene in the lymphoreticular system, polarized light microscopy has important limitations. More refined techniques employing polarized light and other methods of physical and chemical analysis may be necessary to identify polyethylene particles accurately within the lymphoreticular system and periprosthetic tissue.
authors.affiliation: Department of Orthopedics, Univesity of Utah School of Medicine, Salt Lake City, Utah, 84132, USA.
authors.forename: K G
authors.initials: KG
authors.lastname: Shea
authors.forename: R D
authors.initials: RD
authors.lastname: Bloebaum
authors.forename: J M
authors.initials: JM
authors.lastname: Avent
authors.forename: T
authors.initials: T
authors.lastname: Birk
authors.forename: K A
authors.initials: KA
authors.lastname: Samuelson
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D001943:Breast Neoplasms / Q000473:pathology; D003593:Cytoplasm / Q000648:ultrastructure; D016889:Endometrial Neoplasms / Q000473:pathology; D005189:False Positive Reactions; D005260:Female; D005548:Foreign-Body Migration / Q000473:pathology; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D007595:Joint Prosthesis; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008859:Microscopy, Polarization; D008875:Middle Aged; D009367:Neoplasm Staging; D011095:Polyethylenes; D011471:Prostatic Neoplasms / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013499:Surface Properties
chemical_list: D011095:Polyethylenes