title: Distinct immunohistomorphologic changes in periprosthetic hip tissues from historical and highly crosslinked UHMWPE implant retrievals.
abstract: Assessment of immune response to implant wear debris in periprosthetic tissue following total hip arthroplasty suggests that multiple factors are involved in the loss implant function. The current study investigated wear debris and the associated immunohistomorphologic changes in tissues from nine patients with historical (gamma air-sterilized) and nine highly crosslinked UHMWPE implant components. Paraffin embedded tissue sections were evaluated for the presence of histiocytes, giant cells, fibrocartilage/bone, and necrosis. To determine the incidence, degree and co-localization of immunohistomorphologic changes and wear, overlapping full-field tissue arrays were collected in brightfield and polarized light. The historical cohort tissues predominantly showed histiocytes associated with significant accumulations of small wear (0.5-2 microm), and giant cells associated with large wear (> or =2 microm). Frequently, focal regions of necrosis were observed in association with wear debris. For the highly crosslinked cohort, inflammation and associated wear debris were limited, but in tissues from patients revised after implantation times of >2 years a response was observed. Whereas significant amounts of fibrocartilage/bone were observed in patients at earlier implantation times. In both cohorts, tissue responses were more extensive in the retroacetabular or proximal femoral regions. The current findings suggest that wear debris-induced inflammation may be a major contributor to the loss of implant function for both the historical and highly crosslinked cohorts, but it is not the primary cause of early implant loosening. This study highlights the importance of using a more quantitative and standardized assessment of immunohistomorphologic responses in periprosthetic tissues, and emphasizes differences in specific anatomical regions of individual patient tissues.
authors.affiliation: Department of Biomedical Engineering, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Baxter
authors.forename: Allyson
authors.initials: A
authors.lastname: Ianuzzi
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Freeman
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Steinbeck
mesh_terms: D000293:Adolescent; D019644:Arthroplasty, Replacement, Hip; D002648:Child; D003432:Cross-Linking Reagents / Q000494:pharmacology*; D005260:Female; D005269:Femur / Q000187:drug effects / Q000473:pathology; D015726:Giant Cells / Q000187:drug effects / Q000473:pathology; D006621:Hip Joint / Q000187:drug effects / Q000276:immunology* / Q000473:pathology*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D011095:Polyethylenes / Q000494:pharmacology*; D019736:Prostheses and Implants
chemical_list: D003432:Cross-Linking Reagents; D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene