Systemic distribution of wear debris after hip replacement. A cause for concern?

Abstract

The production of particulate wear debris is a recognised complication of joint arthroplasty, but interest has concentrated on local tissue reactions and a possible association with implant loosening. The fate of wear products in the body remains unknown, although some of the metals used in the construction of orthopaedic implants are known to have toxic and oncogenic properties. We report histological and electron-microscopic evidence from two cases which shows that metallic debris can be identified in the lymphoreticular tissues of the body distant from the hip some years after joint replacement. The increase in the use of total arthroplasty in younger patients, the development of new alloys and the use of porous coatings must raise concern for the long-term effects of the accumulation of wear debris in the body.

Sealing effect of hydroxyapatite coating: A 12-month study in canines

“…However, as previously mentioned, this does not exclude the presence of submicron particles. Metal particles from patients with arthroplasties have been demonstrated with electron microscopy and mass spectrometry in tissues such as bone marrow, spleen, liver, lung and kidney (Langkamer et al 1992, Case et al 1994. Widespread dissemination of wear debris should be taken seriously.…”

Systemic and Local Tissue Response to Titanium Corrosion

“…The authors associated the presence of titanium particles in a patient to granulomatous reactions and hepatomegalia. Various studies have reported the presence of macrophages related to failed prostheses, both orthopedic and dental (Adya et al, 2005;Langkamer et al, 1992;Lee et al, 1992;Olmedo et al, 2003;Urban et al, 2002).…”

Effect of chromium and cobalt ions on primary human lymphocytesin vitro

“…In addition, concentrations of Co and Cr ions in hip aspirate (> 10 µM) have been found to be higher than circulating levels (De Smet et al, 2008;Kwon et al, 2009). Furthermore, post-mortem studies have shown extremely high levels of metals (> 100 µM) in organs and tissues after traditional metal hip arthroplasty, for example in the liver, lymph nodes, and spleen (Langkamer et al, 1992;Case et al, 1994).…”