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Bone ingrowth in the presence of particulate polyethylene

SYNERGY BETWEEN INTERFACE MOTION AND PARTICULATE POLYETHYLENE IN PERIPROSTHETIC TISSUE RESPONSE

Orthopaedic Biomechanics Laboratory, Midwest Orthopaedic and Minneapolis Medical Research Foundations

V. Kubic, MD, Medical Staff

Department of Pathology
Hennepin County Medical Centre, 914 South Eighth Street, 860C Minneapolis, Minnesota 55404, USA.

K. Søballe, MD, PhD, Professor

Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus Amtsyggehus, Tage-Hansens Gade, Aarhus C, Denmark.

Correspondence should be sent to Dr J. E. Bechtold.

We have investigated whether the presence of polyethylene (PE) alone is sufficient to cause an aggressive periprosthetic tissue response, or whether certain mechanical interface conditions can allow bone to grow while in the presence of PE. An experimental implant was loaded in the presence and absence of particulate PE under stable and unstable conditions.

Bone with a thin, discontinuous fibrous membrane formed in both groups of stable implants, either in the presence or absence of PE. By contrast, a continuous fibrous membrane consistently formed in both groups of unstable implants. The membrane consisted of loose fibrous connective tissue when PE was absent, and dense connective tissue with macrophages and a synovial lining when PE was present. In this model, if the interface was stable, the presence of PE was not sufficient to prevent the formation of bone or to produce a phagocytic tissue response. Only when the interface was unstable did a fibrous membrane form, and only then in the presence of PE.