title: Does bone wax induce a chronic inflammatory articular reaction?
abstract: BACKGROUND
  Bone wax is used to control femoral neck bleeding during open femoroacetabular impingement (FAI) surgery. Despite its widespread use, only a few case reports and small case series describe side effects after extraarticular use. It is unclear whether intraarticular use of bone wax leads to such complications. However, during revision FAI surgery, we have observed various degrees of articular inflammatory reactions.
  
  
  OBJECTIVE
  We therefore investigated whether the bone wax used intraarticularly to control femoral neck bleeding during FAI surgery could be associated with the inflammatory reactions observed at revision surgery.
  
  
  METHODS
  We visually inspected the area and analyzed biopsy specimens from all 14 patients undergoing revision surgery from March 2005 to March 2006, 11 of whom had bone wax used at the time of original surgery. The three patients who did not have bone wax were used as controls.
  
  
  RESULTS
  Bone wax was identified macroscopically on the femoral neck at the time of the revision surgery in all 11 patients. In all 11 patients, biopsy results indicated a foreign body-type chronic synovial inflammation. Five patients also had an associated synovial lymphoplasmacytic inflammatory reaction. No inflammatory reaction was observed in the biopsy specimens obtained from the three patients in whom bone wax was not originally used.
  
  
  CONCLUSIONS
  Our findings suggest a synovial foreign body reaction, with or without an associated lymphoplasmacytic chronic inflammatory reaction, may be associated with intraarticular use of bone wax.
authors: Discipline of Orthopaedics and Trauma, The University of Adelaide, North Terrace, South Adelaide 5000, Australia. bogdan.solomon@health.sa.gov.au
authors: Lucian B
authors: LB
authors: Solomon
authors: Carlos
authors: C
authors: Guevara
authors: Lorenz
authors: L
authors: Büchler
authors: Donald W
authors: DW
authors: Howie
authors: Roger W
authors: RW
authors: Byard
authors: Martin
authors: M
authors: Beck
mesh_terms: D000293:Adolescent; D000328:Adult; D001168:Arthritis / Q000209:etiology*; D002908:Chronic Disease; D005260:Female; D057925:Femoracetabular Impingement / Q000209:etiology / Q000601:surgery*; D005272:Femur Neck; D005549:Foreign-Body Reaction / Q000276:immunology*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010168:Palmitates / Q000009:adverse effects* / Q000627:therapeutic use; D012086:Reoperation; D014885:Waxes / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D010168:Palmitates; D014885:Waxes; C055480:bone wax