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Giant cell synovitis associated with failed polyethylene patellar replacements

F C Ewald, C B Sledge, J M Corson

    Clinical Orthopaedics and Related Research
    |March 1, 1976
    PubMed
    Summary
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    High molecular weight polyethylene knee prostheses failed within a year in two patients. This was due to giant cell synovitis from polyethylene wear particles articulating against bone and cartilage.

    Area of Science:

    • Orthopedic surgery
    • Biomaterials science
    • Rheumatology

    Background:

    • Patellar resurfacing aims to restore knee function by replacing damaged articular surfaces.
    • High molecular weight polyethylene (HMWPE) is a common material used in orthopedic implants.
    • The patellofemoral joint is critical for knee biomechanics and can be affected by degenerative conditions.

    Observation:

    • Two patients received HMWPE patellar prostheses articulating against bone and cartilage.
    • Both prostheses failed within one year of implantation.
    • Histological examination revealed giant cell synovitis attributed to polyethylene wear particles.

    Findings:

    • A high volume (0.2 cc) of fine polyethylene (1-100 µm) wear particles was identified.
    • These particles triggered an inflammatory response (giant cell synovitis), leading to implant failure.

    Related Experiment Videos

  • The study highlights the adverse reaction to polyethylene particles in direct contact with bone or cartilage.

    • Implications:

    • Ultra-high molecular weight polyethylene (UHMWPE) is unsuitable for direct articulation against bone or degenerative cartilage in major joints.
    • Alternative bearing surfaces or surgical techniques may be necessary to prevent wear particle-induced inflammation.
    • This finding has significant implications for the design and material selection of future patellofemoral implants.