Polyethylene particles in joint fluid and osteolysis in revision total knee arthroplasty.
BACKGROUND
One of the most frequent reasons for total knee arthroplasty late failure is osteolysis. It has been related to foreign body reaction to polyethylene particles. The aim of this study is to analyse the number, size and morphology of polyethylene particles in synovial fluid in total knee arthroplasty revision and correlate them to the pathology and the degree of osteolysis.


METHODS
Synovial fluid was obtained in 12 patients before the revision total knee arthroplasty. Polyethylene particles were isolated and analysed through scanning electron microscopy. Samples of synovial tissue were analysed with optical microscopy while considering the parameters of particles and histiocytic infiltration. Osteolysis was analysed with plain radiography and the macroscopic aspect during surgery.


RESULTS
The statistical analysis showed a significant correlation between a high concentration of polyethylene particles in synovial fluid and a high degree of osteolysis. The concentration of particles in synovial fluid also showed a significant correlation with a high degree of particles and histiocytes in the histological analysis. There was a relationship between the size of particles and the degree of osteolysis. No relationship was found between the shape of the particles and the histological findings or the degree of osteolysis.


CONCLUSIONS
In an "in vivo" TKA scenario, the presence of a high concentration of polyethylene particles in the synovial fluid seems to be the cause of a highly active foreign body histological reaction, with an increased number of histiocytes, which seems to be the cause of a significant degree of osteolysis around the implant.
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain. Electronic address: Ignasipinol@gmail.com.
Ignasi
I
Piñol
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
Alberto
A
Torres
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
Gabriel
G
Gil
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
Eva
E
Prats
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
Lluis
L
Puig-Verdier
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
Pedro
P
Hinarejos
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D006644:Histiocytes / Q000378:metabolism; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D010316:Particle Size; D020959:Polyethylene / Q000032:analysis*; D011446:Prospective Studies; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D013582:Synovial Fluid / Q000737:chemistry* / Q000378:metabolism
D020959:Polyethylene
Polyethylene; joint fluid; osteolysis; total knee arthroplasty