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Do Tissues From THA Revision of Highly Crosslinked UHMWPE Liners Contain Wear Debris and Associated Inflammation?

  • Symposium: UHMWPE for Arthroplasty: From Powder to Debris
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Polyethylene wear debris is a major contributor to inflammation and the development of implant loosening, a leading cause of THA revisions. To reduce wear debris, highly crosslinked ultrahigh-molecular-weight polyethylene (UHMWPE) was introduced to improve wear properties of bearing surfaces. As highly crosslinked UHMWPE revision tissues are only now becoming available, it is possible to examine the presence and association of wear debris with inflammation in early implant loosening.

Questions/purposes

We asked: (1) Does the presence of UHMWPE wear debris in THA revision tissues correlate with innate and/or adaptive immune cell numbers? (2) Does the immune cell response differ between conventional and highly crosslinked UHMWPE cohorts?

Methods

We collected tissue samples from revision surgery of nine conventional and nine highly crosslinked UHMWPE liners. Polarized light microscopy was used to determine 0.5- to 2-μm UHMWPE particle number/mm2, and immunohistochemistry was performed to determine macrophage, T cell, and neutrophil number/mm2.

Results

For the conventional cohort, correlations were observed between wear debris and the magnitude of individual patient macrophage (ρ = 0.70) and T cell responses (ρ = 0.71) and between numbers of macrophages and T cells (ρ = 0.77) in periprosthetic tissues. In comparison, the highly crosslinked UHMWPE cohort showed a correlation between wear debris and the magnitude of macrophage responses (ρ = 0.57) and between macrophage and T cell numbers (ρ = 0.68). Although macrophages and T cells were present in both cohorts, the highly crosslinked UHMWPE cohort had lower numbers, which may be associated with shorter implantation times.

Conclusions

The presence of wear debris and inflammation in highly crosslinked UHMWPE revision tissues may contribute to early implant loosening.

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Acknowledgments

We thank the participating physicians from the Rothman Institute (Dr. Javad Parvizi) and Case Western Reserve University (Dr. Victor Goldberg) who were instrumental in procuring periprosthetic hip tissue samples. We also are grateful to Lauren L. Jablonowski and Robin Stevenson for their contributions to multiple aspects of tissue sample processing.

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Authors and Affiliations

  1. School of Biomedical Engineering, Science and Health Systems, Drexel University, 323 Bossone, 3120 Market Street, Philadelphia, PA, 19104, USA

    Ryan M. Baxter MS & Marla J. Steinbeck PhD

  2. Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    Theresa A. Freeman PhD

  3. Exponent Inc, Philadelphia, PA, USA

    Steven M. Kurtz PhD

Authors
  1. Ryan M. Baxter MS
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  2. Theresa A. Freeman PhD
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  3. Steven M. Kurtz PhD
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  4. Marla J. Steinbeck PhD
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Correspondence to Marla J. Steinbeck PhD.

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One or more of the authors (SMK, MJS) have received funding from the National Institute of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH R01 AR47904).

Each author certifies that his or her institution has approved the human protocols for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Drexel University.

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Baxter, R.M., Freeman, T.A., Kurtz, S.M. et al. Do Tissues From THA Revision of Highly Crosslinked UHMWPE Liners Contain Wear Debris and Associated Inflammation?. Clin Orthop Relat Res 469, 2308–2317 (2011). https://doi.org/10.1007/s11999-010-1713-x

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