The Latest Lessons Learned from Retrieval Analyses of Ultra-High Molecular Weight Polyethylene, Metal-on-Metal, and Alternative Bearing Total Disc Replacements

Abstract

Knowledge regarding the in vivo performance and periposthetic tissue response of cervical and lumbar total disc replacements (TDRs) continues to expand. This review addresses the following four main questions: 1) What are the latest lessons learned from polyethylene in large joints and how are they relevant to current TDRs? 2) What are the latest lessons learned regarding adverse local tissue reactions from metal-on-metal, CoCr bearings in large joints and how are they relevant to current TDRs? 3) What advancements have been made in understanding the in vivo performance of alternative biomaterials, such as stainless steel and polycarbonate urethane, for TDRs in the past five years? 4) How has retrieval analysis of all these various artificial disc bearing technologies advanced the state of the art in preclinical testing of TDRs? The study of explanted artificial discs and their associated tissues can help inform bearing selection as well as the design of future generations of disc arthroplasty. Analyzing retrieved artificial discs is also essential for validating preclinical test methods.

UHMWPE Wear Debris and Tissue Reactions Are Reduced for Contemporary Designs of Lumbar Total Disc Replacements

“…The exact contribution of hemosiderin to revision remains unclear; however, a previous study has associated the deposition with the accumulation of activated macrophages that are positive for osteoclastic cell markers [25]. Although the amount of UHMWPE wear debris in the spine may not be severe enough to directly contribute to osteolysis [18], vertebral osteolysis was noted as a clinical complication in two patients with fixed-bearing L-TDRs, both of whom had tissues containing hemosiderin. The effect of hemosiderin in these tissues on UHMWPE wear-induced inflammation requires further investigation.…”

“…As a result of the decreased sliding distance in metal-on-polyethylene (MoP) L-TDRs compared with THA and TKA, wear and osteolysis of L-TDRs were originally thought to be negligible in the anterior column of the lumbar spine [21,22]. However, studies of historical L-TDRs with c-air-sterilized UHMWPE cores have demonstrated wear of the UHMWPE core along with several cases of osteolysis in the lumbar spine [18,35]. Additionally, both submicron (0.05-2 lm) and large UHMWPE wear particles (C 2 lm) were present in periprosthetic tissues from historical TDRs [29,30].…”

Delayed hypersensitivity reaction caused by metal-on-metal total disc replacement

“…However, the mechanisms leading to such reactions have been reported to be similar to those described after hip arthroplasty. 1,6,7 Only a few cases have been previously reported. 5 The severity of the clinical presentation makes the present case unique.…”

Intervertebral disc joint replacement technology

“…because the wear resistance of metal-on-metal articulation is superior to metal-on-polyethylene, the particulate debris generated by metal-on-metal couples is an order of magnitude less (but higher particle count) than that produced by metal-on-polymer couples. at this time, no adverse events relating to metal particulate debris or ion have been reported for the PRESTigE ® disc (Kurtz et al, 2012). a continuous monitoring of the in vivo biological effects of the metallic wear debris is required.…”