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Related Experiment Videos

Inflammatory response in retrieved noncemented porous-coated implants.

S D Cook1, L C McCluskey, P C Martin

  • 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112.

Clinical Orthopaedics and Related Research
|March 11, 1991
PubMed
Summary

Inflammatory infiltrates were found in 22% of retrieved hip and knee implants. These infiltrates, potentially linked to metal hypersensitivity, were associated with a higher rate of removal due to persistent pain.

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Histopathology

Background:

  • Noncemented porous-coated implants are widely used in hip and knee arthroplasty.
  • Understanding the biological response to these implants is crucial for improving patient outcomes.
  • Tissue ingrowth and inflammatory responses are key factors influencing implant longevity.

Purpose of the Study:

  • To histologically evaluate tissue ingrowth and inflammatory cell infiltrates in retrieved noncemented porous-coated hip and knee implants.
  • To determine the type, amount, and distribution of tissue ingrowth and inflammatory cells.
  • To investigate the association between inflammatory infiltrates and implant removal for pain.

Main Methods:

  • Histological examination of 146 retrieved hip and knee implants from 97 patients.

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  • Assessment of tissue ingrowth, inflammatory cell type and distribution, and vascular proliferation.
  • Correlation of inflammatory infiltrates with implant removal due to persistent pain and implant material (cobalt-chromium vs. titanium).

    • Main Results:

    • An inflammatory infiltrate was present in 22% of implants, predominantly composed of lymphocytes and histiocytes.
    • Vascular proliferation was observed in 9 of 21 cases with infiltrates.
    • Bone ingrowth was present in 10 of 21 cases with infiltrates.
    • A 38% incidence of removal for persistent pain was noted in cases with inflammatory infiltrates.
    • Higher inflammatory infiltrate incidence was observed in titanium devices (40%) compared to cobalt-chromium (20%).

    Conclusions:

    • Inflammatory infiltrates are present in a significant percentage of retrieved noncemented porous-coated implants.
    • These infiltrates may be associated with hypersensitivity or allergic reactions to metal ions.
    • The presence of inflammatory infiltrates correlated with a higher rate of implant removal for persistent pain.
    • The exact etiology of the infiltrates remains unclear and warrants further investigation.