A case of massive osteolysis after knee prosthesis polyethylene failure

Sizes and shapes of micron- and submicron-sized structures in four lots of virgin GUR 4150 HP ultrahigh molecular weight polyethylene powder were determined by using low-voltage scanning electron microscopy and image analysis. One thousand two hundred micron-sized virgin powder particles and 1200 of their constituent submicron-sized structures were analyzed. The mean maximum diameter of the micron-sized particles was 81.3 microns, and that of the submicron-sized particles was 0.82 micron. Particle shapes, as determined by the aspect ratio (maximum diameter divided by minimum diameter), were remarkably consistent from lot to lot and between micron- and submicron-sized particles (1.55 versus 1.53, respectively). Significant lot to lot variability was observed in the sizes of the micron-sized particles, and the size distribution of the submicron-sized particles closely follows the size distribution of the submicron-sized particles observed in tissue retrievals. This variability leads to questions about variability in polyethylene quality and in vivo wear performance. Size similarity between the submicron-sized particles retrieved from tissues and that observed in virgin powder supports the hypothesis that polyethylene debris has two origins: particles released from structures retained from the virgin powder, and particles generated de novo by friction and wear.

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Shape and size of virgin ultrahigh molecular weight GUR 4150 HP polyethylene powder

Pienkowski

Hoglin

Jacob

et al. 1996

J. Biomed. Mater. Res.

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Metal ion release from wear particles produced by Ti-6Al-4V and Co-Cr alloy surfaces articulating against bone

Browne

Gregson

1995

Materials Letters

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Total Hip Replacement pseudotumoral osteolysis

Bourghli

Fabre

Tramond³

et al. 2010

Orthopaedics & Traumatology: Surgery & Research

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We report three cases of pseudotumoral lesion secondary to total hip replacement using metal on polyethylene bearings, presenting two distinct macroscopic aspects: (a) classic inflammatory granuloma and, in one case, (b) onset of hematoma associated with gluteal vessel lesions, probably affected by the pseudotumoral process. Diagnosis was radiographic, with CT-scan serving to confirm and, more importantly, to reveal extension and analyze surrounding tissue. Arteriography is needed when the lesion is liquid, and biopsy may be envisaged depending upon the clinical situation. In all three cases, histology was typically that of granulomatous lesions related to wear debris. Once diagnosis could be established, treatment was similar in both presentations, with surgical revision, which should be as early as possible in case of cortical bone involvement, to prevent pathologic fracture.

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A case of massive osteolysis after knee prosthesis polyethylene failure

Cited by 7 publications

References 13 publications

Shape and size of virgin ultrahigh molecular weight GUR 4150 HP polyethylene powder

Shape and size of virgin ultrahigh molecular weight GUR 4150 HP polyethylene powder

Metal ion release from wear particles produced by Ti-6Al-4V and Co-Cr alloy surfaces articulating against bone

Total Hip Replacement pseudotumoral osteolysis

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