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Silicone elastomer microshards in fluid from a painful metatarsophalangeal implant site. A case report
G N Friedlander1, G K Potter, R S Tucker
1Foot Care Surgicenter, Sun City, Arizona, USA.
Abstract:
Histopathologic studies have demonstrated microshards from silicone elastomer metatarsophalangeal joint implants in adjacent tissues in a setting of chronic inflammation and in inguinal lymph nodes. Cytologic smears of synovial fluid from symptomatic implanted joints should show these refractile, nonpolarizing microshards in the reactive inflammatory context. Nonspecific enzymatic inflammatory activity contributes to further destabilization of the implants, eventuating in symptoms and signs requiring prosthesis removal. Cytopathologic examination of aspirated fluid from the vicinity of a symptomatic implanted joint demonstrates foreign body reaction to silicone elastomer, predicting a need for intervention before the local damage is severe and disabling.
Insights
Microscopic silicone elastomer fragments from joint implants can cause chronic inflammation and necessitate prosthesis removal. Early cytopathologic detection of these microshards aids in timely intervention for symptomatic patients.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Pathology
Background:
- Silicone elastomer implants are used in metatarsophalangeal joint arthroplasty.
- Chronic inflammation and implant failure are potential complications.
Observation:
- Histopathology reveals silicone elastomer microshards in tissues adjacent to implants and in lymph nodes.
- Cytologic examination of synovial fluid shows these microshards within a reactive inflammatory milieu.
Findings:
- Nonspecific enzymatic inflammatory activity exacerbates implant destabilization.
- The presence of microshards and inflammation predicts the need for prosthesis removal.
Implications:
- Early cytopathologic diagnosis of silicone microshards is crucial for symptomatic patients.
- Timely intervention can prevent severe, disabling local damage associated with implant failure.
