Few complications have been reported for lumbar total disc replacement (TDR) and hybrid TDR fixations. This study evaluated retrieved implants and periprosthetic tissue reactions for two cases of osteolysis following disc arthroplasty with ProDisc-L prostheses.
Implants were examined for wear and surface damage, and tissues for inflammation, polyethylene wear debris (polarized light microscopy) and metal debris (energy-dispersive X-ray spectroscopy).
Despite initial good surgical outcomes, osteolytic cysts were noted in both patients at vertebrae adjacent to the implants. For the hybrid TDR case, heterotopic ossification and tissue necrosis due to wear-induced inflammation were observed. In contrast, the non-hybrid implant showed signs of abrasion and impingement, and inflammation was observed in tissue regions with metal and polyethylene wear debris.
In both cases, wear debris and inflammation may have contributed to osteolysis. Surgeons using ProDisc prostheses should be aware of these rare complications.
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We thank Eual Phillips for his help in performing the image analysis for this study.
Conflict of interest
This study was supported by a grant from the NIAMS (NIH R01 AR56264). Institutional support was received from Medtronic and DePuy Synthes for research unrelated to this work (SMK). For THL, he is a consultant and receives royalties from Medtronic.
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Veruva, S.Y., Lanman, T.H., Hanzlik, J.A. et al. Rare complications of osteolysis and periprosthetic tissue reactions after hybrid and non-hybrid total disc replacement. Eur Spine J 24 (Suppl 4), 494–501 (2015). https://doi.org/10.1007/s00586-014-3535-0
- Chronic inflammation
- Hybrid fixation
- Metal wear debris
- Polyethylene wear debris
- Total disc replacement