title: Characterization of wear debris in total elbow arthroplasty.
abstract: BACKGROUND
  The purpose of this study was to evaluate wear debris in periprosthetic tissues at the time of revision total elbow arthroplasty. Polyethylene, metallic, and bone cement debris were characterized, and the tissue response was quantified.
  
  
  METHODS
  Capsular and medullary tissue samples were collected during revision surgery. Polyethylene debris was characterized by scanning electron microscopy after tissue digestion. The concentrations of metal and cement debris were quantified by inductively coupled plasma mass spectrometry. Tissue response was graded with a semiquantitative histologic method.
  
  
  RESULTS
  Polyethylene particle size varied from the submicron range to over 100 μm. The mean diameter ranged from 0.6 μm to about 1 μm. Particles in the synovial tissues were larger and less abundant than those in tissues from the medullary canal. Cement, titanium alloy, and low levels of cobalt-chrome debris were also present, with cement predominating over metal debris. Histiocyte response was associated with small polyethylene particles (0.5-2 μm), and giant cells were associated with large polyethylene particles (>2 μm). Histiocyte scores positively correlated with the polyethylene particle number and the presence of metal.
  
  
  CONCLUSIONS
  We have shown that periprosthetic tissues of total elbow patients who have undergone revision for loosening and osteolysis contain polyethylene, cement, and metal debris. Although the polyethylene particles were of a size and shape that have been previously shown to result in activation of phagocytic cells, osteolysis after total elbow arthroplasty is a multimodal process. Because of the presence of multiple wear particle sources, a cause-and-effect relationship between polyethylene debris and osteolysis cannot be established with certainty.
authors.affiliation: Implant Research Center, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA 19104, USA. jday@exponent.com
authors.forename: Judd S
authors.initials: JS
authors.lastname: Day
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Baxter
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Ramsey
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Morrey
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Connor
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Steinbeck
mesh_terms: D000368:Aged; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects* / Q000379:methods; D016477:Artifacts; D001843:Bone Cements / Q000032:analysis; D002858:Chromium Alloys / Q000032:analysis; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000473:pathology* / Q000648:ultrastructure; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010014:Osteolysis / Q000175:diagnosis / Q000209:etiology*; D010316:Particle Size; D011095:Polyethylenes / Q000032:analysis; D011300:Preoperative Care / Q000379:methods; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D014025:Titanium / Q000032:analysis
chemical_list: D001843:Bone Cements; D002858:Chromium Alloys; D011095:Polyethylenes; D014025:Titanium