The peri-prosthetic tissue response to wear debris
is complex and influenced by various factors including the size, area
and number of particles. We hypothesised that the ‘biologically
active area’ of all metal wear particles may predict the type of
peri-prosthetic tissue response. . Peri-prosthetic tissue was sampled from 21 patients undergoing
revision of a small diameter metal-on-metal (MoM) total hip arthroplasty
(THA) for aseptic loosening. An enzymatic protocol was used for
tissue digestion and scanning electron microscope was used to characterise
particles. Equivalent circle diameters and particle areas were calculated.
Histomorphometric analyses were performed on all tissue specimens.
Aspirates of synovial fluid were collected for analysis of the cytokine
profile analysis, and compared with a control group of patients
undergoing primary THA (n = 11) and revision of a failed ceramic-on-polyethylene
arthroplasty (n = 6). . The overall distribution of the size and area of the particles
in both lymphocyte and
non-lymphocyte-dominated responses were similar; however, the subgroup
with lymphocyte-dominated peri-prosthetic tissue responses had a
significantly larger total number of particles. . 14 cytokines (interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-10,
IL-13, IL-17, interferon (IFN)-γ, and IFN-gamma-inducible protein
10), chemokines (macrophage inflammatory protein (MIP)-1α and MIP-1ß),
and growth factors (granulocyte macrophage colony stimulating factor
(GM-CSF) and platelet derived growth factor) were detected at significantly higher
levels in patients with metal wear debris compared with the control
group. . Significantly higher levels for IL-1ß, IL-5, IL-10 and GM-CSF
were found in the subgroup of tissues from failed MoM THAs with
a lymphocyte-dominated peri-prosthetic response compared with those
without this response. . These results suggest that the ‘biologically active area’ predicts
the type of
peri-prosthetic tissue response. The cytokines IL-1ß, IL-5, IL-10,
and GM-CSF are associated with lymphocyte-dominated tissue responses
from failed small-diameter MoM THA. Cite this article:
Total hip replacement (THR) is a very common
procedure undertaken in up to 285 000 Americans each year. Patient
satisfaction with THR is very high, with improvements in general
health, quality of life, and function while at the same time very
cost effective. Although the majority of patients have a high degree
of satisfaction with their THR, 27% experience some discomfort,
and up to 6% experience severe chronic pain. Although it can be
difficult to diagnose the cause of the pain in these patients, this
clinical issue should be approached systematically and thoroughly.
A detailed history and clinical examination can often provide the
correct diagnosis and guide the appropriate selection of investigations, which
will then serve to confirm the clinical diagnosis made. . Cite this article:
We performed a case–control study to compare
the rates of further surgery, revision and complications, operating time
and survival in patients who were treated with either an uncemented
hydroxyapatite-coated Corail bipolar femoral stem or a cemented
Exeter stem for a displaced intracapsular fracture of the hip. The
mean age of the patients in the uncemented group was 82.5 years
(53 to 97) and in the cemented group was 82.7 years (51 to 99) We used
propensity score matching, adjusting for age, gender and the presence
or absence of dementia and comorbidities, to produce a matched cohort
receiving an Exeter stem (n = 69) with which to compare the outcome of
patients receiving a Corail stem (n = 69). The Corail had a significantly
lower all-cause rate of further surgery (p = 0.016; odds ratio (OR)
0.18, 95% CI 0.04 to 0.84) and number of hips undergoing major further
surgery (p = 0.029; OR 0.13, 95% CI 0.01 to 1.09). The mean operating
time was significantly less for the Corail group than for the cemented Exeter
group (59 min [12 to 136] vs 70 min [40 to 175],
p = 0.001). The Corail group also had a lower risk of a peri-prosthetic
fracture (p = 0.042; OR 0.19, 95% CI 0.01 to 1.42) . There was no
difference in the mortality rate between the groups. There were
significantly fewer complications in the uncemented group, suggesting
that the use of this stem would result in a decreased rate of morbidity
in these frail patients. Whether this relates to an improved functional
outcome remains unknown. Cite this article:
