title: Wear particulate species and bone loss in failed total joint arthroplasties.
abstract: The aim of this study was to evaluate the relative contribution of polyethylene, metal, and polymethylmethacrylate (cement) particles to the overall bone loss in aseptic loosening. Twenty-four interface tissues with adjacent bone were obtained during 17 revision total joint arthroplasties (11 hips and six knees). Osteoclasts and macrophages were identified immunohistochemically on the bone surface. The length of the bone surface in contact with these cell types was measured and analyzed with reference to the particulate species present within the fibrous interface. The presence of abundant polyethylene particles significantly increased the proportion of the bone surface in contact with macrophages but did not have a significant influence on that of osteoclasts. Osteoclastic bone resorption was significantly more extensive in the presence of metal particles. In contrast, the presence of cement particles did not have a significant influence on macrophage or osteoclast coverage of the bone surface. These results highlight the significance of polyethylene particles in macrophage recruitment and subsequent osteolysis and suggest a different mechanism of bone loss related to metal, namely mediation through osteoclastic activities. The relative contribution of cement particles was negligible and needs reevaluation in light of evidence provided by others.
authors.affiliation: Department of Histopathology, Royal Free Hospital School of Medicine, London, United Kingdom.
authors.forename: Y
authors.initials: Y
authors.lastname: Kadoya
authors.forename: P A
authors.initials: PA
authors.lastname: Revell
authors.forename: A
authors.initials: A
authors.lastname: Kobayashi
authors.forename: N
authors.initials: N
authors.lastname: al-Saffar
authors.forename: G
authors.initials: G
authors.lastname: Scott
authors.forename: M A
authors.initials: MA
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000601:surgery; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D010010:Osteoclasts / Q000473:pathology; D010014:Osteolysis; D011095:Polyethylenes; D011475:Prosthesis Failure; D012086:Reoperation; D013167:Spondylitis, Ankylosing / Q000601:surgery
chemical_list: D011095:Polyethylenes