Comparison and quantitation of wear debris of failed total hip and total knee arthroplasty

Abstract

To compare the physical properties of debris particles associated with failed total hip and total knee arthroplasty, we applied a recently developed assay to electronically characterize the size, number, and composition of debris particles isolated from tissues adjacent to failed implants. We identified 21 samples (from 20 patients) of hip synovia and 35 samples (from 32 patients) of knee tissues that had been obtained at the time of revision arthroplasty. There were 12 females and 9 males in the hip group, and 16 females and 19 males in the knee group. Primary arthroplasty was performed for osteoarthritis (OA, 15 cases) or rheumatoid arthritis (RA, 6 cases) in the hip, and for OA (23) or RA (12) in the knee. Patients ranged in age from 23 to 85 (mean 59 years) for total hip, and from 27 to 84 (mean 61 years) for total knee arthroplasty. Implantation duration was from 5 to 123 months (mean 37.8) for total hip, and from 11 to 123 months (mean 63.1) for total knee arthroplasty. All of the implants were composed of cobalt-chromium alloy articulating with ultrahigh-molecular-weight polyethylene. The number of particles smaller than 10 microns ranged from 1.04 x 10(8)/g to 1.91 x 10(10)/g in the hip, and from 6.69 x 10(8)/g to 2.13 x 10(10)/g in the knee. Energy-dispersive X-ray spectroscopy and polarized light analysis showed both polyethylene and metal particles in most cases. The mean diameter of particles smaller than 10 microns was 0.72 +/- 0.2 microns in the hip, and 0.74 +/- 0.1 microns in the knee. Evaluation of particles larger than 10 microns showed a larger range of particle size in knee tissues (maximum 6.1 mm, mean 283 microns), than in the hip tissues (maximum 826 microns, mean 81 microns) (p < 0.001). Very small particles are common in both groups, but it appears that a larger range of particle sizes is present adjacent to failed knee than to failed hip prostheses. The higher frequency of large particles in failed knee prostheses probably reflects the perceived higher rate of delamination and fragmentation of tibial and patellar compared to that of acetabular polyethylene.