Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up

Abstract

Background Adverse local tissue reactions have been problematic as an implant-related complication in total hip arthroplasty (THA). Despite the absence of significant metal wear and corrosion, granulomatous pseudotumor has been reported to be caused by polyethylene wear. We performed a long-term follow-up study investigating the relationship between polyethylene wear and pseudotumor formation in THA. Methods This study included 57 patients (64 hips) that underwent primary THA with metal-on-polyethylene or ceramic-on-polyethylene bearing over a minimum follow-up of 15 years. They were stratified into pseudotumor and non-pseudotumor groups and their linear wear rates of polyethylene liner and serum cobalt (Co) and chromium (Cr) ion levels were compared. Pseudotumor was diagnosed on metal artifact reduction sequence-MRI according to its composition and wall thickness using the Hauptfleisch classification. Results The incidence of pseudotumor was 34% (22/64 hips) at the mean follow-up of 16.9 years. Metal ion levels did not differ between the pseudotumor and non-pseudotumor groups, and none of the patients exceeded the Co/Cr ratio of 2.0 μg/L. Moreover, the wear rate in the pseudotumor group was 1.8 times greater than in the non-pseudotumor group (0.14 vs. 0.08 mm/year, P < 0.001). According to an analysis of the receiver operating characteristic curves, the cutoff level of the wear rate to discriminate between pseudotumor and non-pseudotumor patients at 15 years was 0.11 mm/year (area under the curve = 91%; sensitivity = 95%; specificity = 78%; accuracy = 87%). Conclusions Our results might provide new insights into excessive polyethylene wear potentially leading to the future development of both pseudotumor and osteolysis. Further studies are needed to clarify the direct relationship between polyethylene wear and pseudotumor and the mutual effects of osteolysis and pseudotumor in particle reactions.

No Difference in Revision Rates and High Survival Rates in Large-head Metal-on-metal THA Versus Metal-on-polyethylene THA: Long-term Results of a Randomized Controlled Trial

“…The number of pseudotumors (20 of 36 in the MoM group) in our study agrees with the work of others [10,26,31]. Pseudotumor formation in MoP THA was also observed in our study, and this is a well-known implant-related complication in MoP THA [14,15]. Adverse reactions to metal debris in MoP THA have been associated with mechanical wear and corrosion of metallic components at the modular head-stem taper junction or might be related to modular stems [22,35].…”

“…However, adverse reactions to metal debris in patients with MoP prostheses are also seen in patients without metal wear owing to foreign body reactions to polyethylene wear particles [22]. Additionally, adverse reactions could occur because of polyethylene wear, even though adverse reactions to metal debris have a different origin [1, 7, 14, 15].…”

The effect and mechanism of iodophors on the adhesion and virulence of Staphylococcus aureus biofilms attached to artificial joint materials

“…Several studies have shown that iodine-supported titanium implants can inhibit biofilm formation [ 41 , 42 ]. Polyethylene joint prostheses are prone to infection and wear [ 43 ]. Rough cobalt chromium molybdenum (CoCrMo) surfaces are prone to biofilms showing more proteins and polysaccharides, while the effect of iodophor treatment is still unknown [ 24 ].…”

Updates on Biomaterials Used in Total Hip Arthroplasty (THA)

“…At the same time, in sterilizing methods, wear is controlled by cross-linking [ 59 , 61 ]. Also, in a recent study, Slouf et al [ 56 ] predicted that oxidative degradation will increase once the median lifetime of the UHMWPE liner in vivo increases and a study of Ishida’s group also predicted this [ 66 ].…”