Abstract
PURPOSE OF THE STUDY The orthopaedic community has unanimously adopted the view that ultra high molecular weight polyethylene (UHMWPE) wear particles are a very frequent cause of aseptic implant loosening. Some studies have tried to provide objective evidence for this.
We have found descriptions of particle distribution or morphology, but no report that would objectively correlate the number of particles in zones surrounding an implant with the extent of damage to these zones. The aim of this study was to develop a method allowing us to evaluate a number of samples with polyethylene abrasive wear large enough to find association between the extent of damage around a THA and the number of biologically active UHMWPE wear particles, 0.1 to 10 μm in size.
MATERIAL AND METHODS In 28 patients undergoing revision total hip arthroplasty (THA) at the 1st Orthopaedic Clinic, 1st Faculty of Medicine, Charles University, we took samples of typical osteoaggressive granuloma from defined zones around the implant; the zones corresponded to those described by Gruen and DeLee. The extent of tissue damage in each zone was evaluated on the basis of pre-operative radiographs and by the extent of osteolysis and damage to soft tissues actually observed during revision THA.
The volume of wear particles in each zone was assessed by the IRc method developed by us; this is based on a quantitative evaluation of infrared spectra. To verify the methodology, a comparison between tissue damage and the number of particles in each zone was made in three randomly selected patients.
RESULTS We introduced a method of detailed orthopaedic evaluation which enabled us to categorize zones around a revised THA according to the extent of damaged tissue. As a result, a series of zones ranked by the extent of damaged tissue, or an "orthopaedist?s statement" (OS), was obtained.
At the same time we adopted a method, based on infrared spectroscopy and termed IRc, by which the number of particles in the samples of damaged tissues and osteoaggressive granulomas collected from the area around a revised THA was determined. The results of evaluation were presented as numerical data that, in a defined way, were converted into a series of zones ranked according to the number of wear particles, i.e., the "result of measurement" (RM).
In this study we verified the methods described above and made a comparison of OSs and RMs for three randomly selected patients. The very good agreement found confirmed the reliability of both methods which will soon be used to evaluate a group of patients large enough to provide statistically significant results.
DISCUSSION The IRc method determines a total volume of UHMWPE wear particles, 0.1 to 10 μm in size, which are generally considered to be most biologically active. This study suggests that the distribution of particles around a THA is uneven and that relation between tissue damage and the number of wear particles in individual zones surrounding a THA does exist.
The major conclusion from the orthopaedic point of view is a confirmation of the assumption that UHMWPE wear particles are one of the chief causes of THA failure. Although this fact is generally accepted, studies correlating the number of particles with tissue damage and osteolysis in individual zones are very scarce.
CONCLUSIONS The quick and simple IRc method offers a possibility to quantify polyethylene wear particles in soft tissues. The number of 0.1 to 10 μm wear polyethylene particles correlated with pre-operative radiographic findings and orthopaedic evaluation of revision THAs in three randomly selected patients.
The confirmed correlation between the extent of tissue damage in individual zones surrounding a THA and the volume of wear particles detected in these zones supports the view that UHMWPE wear particles are one of the main causes of THA failure.