1/12. Extensive osteolytic cystlike area associated with polyethylene wear debris adjacent to an aseptic, stable, uncemented unicompartmental knee prosthesis: case report.We present the case of a patient who after uncemented unicompartmental knee arthroplasty developed a large osteolytic cystlike area in the lateral aspect of the tibial metaphysis, contralateral to a well-fixed tibial component at revision surgery. The lesion contained fibrotic soft tissue, evidence of a foreign-body giant cell reaction and polyethylene particles, but no metal wear debris, infection, or malignancy. This case demonstrates that there is a direct communication between the joint cavity and the cyst.- - - - - - - - - - ranking = 1keywords = foreign-body (Clic here for more details about this article) |
2/12. Histologic and quantitative wear particle analyses of tissue around cementless ceramic total knee prostheses.We histologically analyzed tissue biopsy specimens obtained from 4 cases of revised cementless ceramic knee prostheses. Particles were isolated from the specimens, and their size and composition were determined. Implants were removed for aseptic loosening at an average of 64 months. Histologically, polyethylene particles were seen in all cases. The concentration of the particles showed wide variation among cases. The concentration of the particles also showed a wide variation among different biopsy locations, suggesting that the particles were not distributed uniformly around the knee prostheses. Although we analyzed only 4 cases, our results show good correlation between radiographic evidence of geographic osteolysis and the concentration of wear particles. Multiple biopsy specimens may be necessary to characterize adequately particle migration around knee prostheses.- - - - - - - - - - ranking = 0.0005729791183011keywords = migration (Clic here for more details about this article) |
3/12. polyethylene wear debris and long-term clinical failure of the Charite disc prosthesis: a study of 4 patients.STUDY DESIGN: A clinical case series of 4 patients undergoing anterior lumbar revision due to failure of total disc replacement surgery. OBJECTIVES: To assess the clinical significance of polyethylene wear debris in salvage surgery after initial total disc replacement, the pattern and the mechanisms of polyethylene wear in the retrieved cores, and the extent of polyethylene debris in the periprosthetic tissues obtained from 4 patients. SUMMARY OF BACKGROUND DATA: Previous in vitro wear tests have demonstrated low wear rates for lumbar artificial discs, suggesting that implant wear may not be a clinically relevant issue with total disc replacement. However, only long-term clinical investigations with analysis of retrieved implants and periprosthetic tissue can ultimately establish the significance of polyethylene wear debris for total disc arthroplasty. methods: Starting in 2004, we began routinely performing salvage procedures in patients with failed total disc replacements. We report on the short-term outcomes of 4 patients at our institution who were revised with a Charite prosthesis (DePuy spine, Raynham, MA). Wear analysis of the retrieved prosthesis and histologic examination of the periprosthetic tissue were also performed. RESULTS: All of the retrieved polyethylene cores showed evidence of wear, but the extent and severity varied among the 4 patients. Wear and fracture of the core were associated with osteolysis of the underlying sacrum in 1 patient. Histologic examination of the periprosthetic tissues confirmed the presence of wear debris lying in inflammatory fibrous tissue. In 3 of the 4 patients, implant wear was associated with an unfavorable biomechanical environment (e.g., subsidence, migration, undersizing, and adjacent fusion). The mechanisms of wear included adhesive/abrasive wear of the central domed region of the polyethylene core, as well as chronic rim impingement, resulting in rim fatigue and fracture. CONCLUSIONS: This study demonstrates the clinical significance of polyethylene wear debris and the potential for osteolysis with total disc replacements. The authors recommend that patients undergoing lumbar disc arthroplasty receive long-term follow-up to monitor the wear and functional status of their implants.- - - - - - - - - - ranking = 0.0005729791183011keywords = migration (Clic here for more details about this article) |
4/12. Localized osteolysis in stable, non-septic total hip replacement.We are reporting four cases of extensive, localized bone resorption adjacent to a rigidly anchored, cemented total hip replacement. None of these hips showed evidence of infection on clinical, bacteriological, or pathological evaluation. The tissue from the regions of osteolysis showed sheets of macrophages and foreign-body giant cells invading the femoral cortices. Abundant methylmethacrylate particulate debris was present in the tissues, but polyethylene wear debris was absent. The histological appearance of this tissue resembled that reported about loosened total hip implants with the exception of the synovial-like layer at the cement surface. The cases reported here show that aggressive bone lysis may occur around stable cemented total hip arthroplasties without the presence of sepsis or malignant disease.- - - - - - - - - - ranking = 1keywords = foreign-body (Clic here for more details about this article) |
5/12. osteolysis, wear and failure of a migrating acetabular component. A roentgen stereophotogram case report.The migration of an acetabular component, revised 12 years postoperatively, was clearly detectable within the first year after operation by roentgen stereophotogram analysis. The failure was probably the result of an early initiated prosthetic loosening.- - - - - - - - - - ranking = 0.0005729791183011keywords = migration (Clic here for more details about this article) |
6/12. osteolysis around an uncemented cobalt chrome total hip arthroplasty.One hundred consecutive uncemented Porous Coated Anatomic total hip arthroplasties performed in 91 patients who obtained prospective serial clinical and radiographic evaluation during a minimum 7-year followup period were studied for the occurrence, extent, and progression of localized periprosthetic bone loss (osteolysis). Periprosthetic bone loss occurred around the femoral component in 11 hips, the acetabular component in 2 hips, and both components in 2 hips during the followup interval. The bone loss was progressive in 6 hips (2 of 11 femoral cases, 2 of 2 acetabular cases, and 2 of 2 both component cases). It frequently occurred around components that showed no evidence of acetabular migration or femoral subsidence (11 of 15 cases). The average age at surgery of patients in the bone loss group was 10 years younger than the nonbone loss group (in the 100 hip cohort). Clinically, most patients with bone loss were asymptomatic, with the average Harris hip rating of 92.4 points (range, 85-99 points). With this particular device at this interval of followup (7 years), the acetabular and the proximal femoral osteolytic lesions are of greatest concern. Wear of the acetabular component was greater for cases with osteolysis than for those without osteolysis, but the difference was not significant.- - - - - - - - - - ranking = 0.0005729791183011keywords = migration (Clic here for more details about this article) |
7/12. osteolysis associated with cemented total knee arthroplasty. A case report.osteolysis induced by particulate debris occurs within 5 years after cementless total knee arthroplasty, but has not been reported to be a problem after cemented total knee arthroplasty. It has been suggested that the bone-cement interface may form a barrier to polyethylene-debris migration, thereby limiting bone loss. The authors have observed osteolysis in a 75-year-old woman 9 years after cemented total knee arthroplasty. An osteolytic area appeared to return to an area of normal bone architecture 3 years after the removal of synovium and particulate debris without implant revision.- - - - - - - - - - ranking = 0.0005729791183011keywords = migration (Clic here for more details about this article) |
8/12. Fracture of the tibial tray following PCA knee replacement. A report of two cases.We report two cases in which fracture of the tibial metal tray was thought to be due to improper design of the tray and heavy polyethylene wear. The bone beneath the fractured portion of the tray was deficient and had been replaced by granulomatous fibrous tissue including numerous polyethylene wear particles and foreign-body giant cells. osteolysis occurred as a tissue reaction to these particles.- - - - - - - - - - ranking = 1keywords = foreign-body (Clic here for more details about this article) |
9/12. Foreign body reactions to absorbable implant fixation of osteotomies.The authors present two case studies which describe a destructive, nonspecific foreign-body reaction encountered while using the Biofix absorbable rod system. At Dallas family Hospital, the Biofix system has been used in 32 first metatarsal procedures, 10 lesser metatarsal procedures, and 15 digital procedures. Twenty-seven patients are included, with two developing a reaction that required surgical drainage and debridement. The first reaction was noted to be extremely violent with destruction of bone and soft tissue. Prompt diagnosis and aggressive therapy is necessary to minimize the soft tissue and bony destruction that may occur. Surgical drainage and debridement are often necessary to control the reaction.- - - - - - - - - - ranking = 1keywords = foreign-body (Clic here for more details about this article) |
10/12. An osteolytic lesion associated with polyethylene wear debris adjacent to a stable total knee prosthesis.Seven years after total knee arthroplasty, a patient with a well-fixed, uncemented femoral component (cobalt-chromium-molybdenum alloy) developed a large cystic lesion in the distal femur adjacent to the femoral component. This lesion contained fibrotic soft tissue, evidence of a foreign-body giant cell reaction, and a large number of polyethylene particles, but no metal wear debris, infection, or malignancy.- - - - - - - - - - ranking = 1keywords = foreign-body (Clic here for more details about this article) |
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