Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up
Abstract Background Adverse local tissue reactions have been problematic as an implant-related complication in total hip arthroplasty (THA). Despite the absence of significant metal wear and corrosion, granulomatous pseudotumor has been reported to be caused by polyethylene wear. We performed a long...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-03634-7 |
| _version_ | 1797864100542283776 |
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| author | Tsunehito Ishida Toshiyuki Tateiwa Yasuhito Takahashi Toshinori Masaoka Takaaki Shishido Kengo Yamamoto |
| author_facet | Tsunehito Ishida Toshiyuki Tateiwa Yasuhito Takahashi Toshinori Masaoka Takaaki Shishido Kengo Yamamoto |
| author_sort | Tsunehito Ishida |
| collection | DOAJ |
| description | Abstract Background Adverse local tissue reactions have been problematic as an implant-related complication in total hip arthroplasty (THA). Despite the absence of significant metal wear and corrosion, granulomatous pseudotumor has been reported to be caused by polyethylene wear. We performed a long-term follow-up study investigating the relationship between polyethylene wear and pseudotumor formation in THA. Methods This study included 57 patients (64 hips) that underwent primary THA with metal-on-polyethylene or ceramic-on-polyethylene bearing over a minimum follow-up of 15 years. They were stratified into pseudotumor and non-pseudotumor groups and their linear wear rates of polyethylene liner and serum cobalt (Co) and chromium (Cr) ion levels were compared. Pseudotumor was diagnosed on metal artifact reduction sequence-MRI according to its composition and wall thickness using the Hauptfleisch classification. Results The incidence of pseudotumor was 34% (22/64 hips) at the mean follow-up of 16.9 years. Metal ion levels did not differ between the pseudotumor and non-pseudotumor groups, and none of the patients exceeded the Co/Cr ratio of 2.0 μg/L. Moreover, the wear rate in the pseudotumor group was 1.8 times greater than in the non-pseudotumor group (0.14 vs. 0.08 mm/year, P < 0.001). According to an analysis of the receiver operating characteristic curves, the cutoff level of the wear rate to discriminate between pseudotumor and non-pseudotumor patients at 15 years was 0.11 mm/year (area under the curve = 91%; sensitivity = 95%; specificity = 78%; accuracy = 87%). Conclusions Our results might provide new insights into excessive polyethylene wear potentially leading to the future development of both pseudotumor and osteolysis. Further studies are needed to clarify the direct relationship between polyethylene wear and pseudotumor and the mutual effects of osteolysis and pseudotumor in particle reactions. |
| first_indexed | 2024-04-09T22:46:07Z |
| format | Article |
| id | doaj.art-9dd9ee1160f446f582e0ef7681539dad |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-09T22:46:07Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-9dd9ee1160f446f582e0ef7681539dad2023-03-22T11:51:15ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-02-0118111010.1186/s13018-023-03634-7Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-upTsunehito Ishida0Toshiyuki Tateiwa1Yasuhito Takahashi2Toshinori Masaoka3Takaaki Shishido4Kengo Yamamoto5Department of Orthopedic Surgery, Tokyo Medical UniversityDepartment of Orthopedic Surgery, Tokyo Medical UniversityDepartment of Orthopedic Surgery, Tokyo Medical UniversityDepartment of Orthopedic Surgery, Tokyo Medical UniversityDepartment of Orthopedic Surgery, Tokyo Medical UniversityDepartment of Orthopedic Surgery, Tokyo Medical UniversityAbstract Background Adverse local tissue reactions have been problematic as an implant-related complication in total hip arthroplasty (THA). Despite the absence of significant metal wear and corrosion, granulomatous pseudotumor has been reported to be caused by polyethylene wear. We performed a long-term follow-up study investigating the relationship between polyethylene wear and pseudotumor formation in THA. Methods This study included 57 patients (64 hips) that underwent primary THA with metal-on-polyethylene or ceramic-on-polyethylene bearing over a minimum follow-up of 15 years. They were stratified into pseudotumor and non-pseudotumor groups and their linear wear rates of polyethylene liner and serum cobalt (Co) and chromium (Cr) ion levels were compared. Pseudotumor was diagnosed on metal artifact reduction sequence-MRI according to its composition and wall thickness using the Hauptfleisch classification. Results The incidence of pseudotumor was 34% (22/64 hips) at the mean follow-up of 16.9 years. Metal ion levels did not differ between the pseudotumor and non-pseudotumor groups, and none of the patients exceeded the Co/Cr ratio of 2.0 μg/L. Moreover, the wear rate in the pseudotumor group was 1.8 times greater than in the non-pseudotumor group (0.14 vs. 0.08 mm/year, P < 0.001). According to an analysis of the receiver operating characteristic curves, the cutoff level of the wear rate to discriminate between pseudotumor and non-pseudotumor patients at 15 years was 0.11 mm/year (area under the curve = 91%; sensitivity = 95%; specificity = 78%; accuracy = 87%). Conclusions Our results might provide new insights into excessive polyethylene wear potentially leading to the future development of both pseudotumor and osteolysis. Further studies are needed to clarify the direct relationship between polyethylene wear and pseudotumor and the mutual effects of osteolysis and pseudotumor in particle reactions.https://doi.org/10.1186/s13018-023-03634-7Adverse local tissue reactionALTRPseudotumorTotal hip arthroplastyPolyethylene wearMetal-on-polyethylene |
| spellingShingle | Tsunehito Ishida Toshiyuki Tateiwa Yasuhito Takahashi Toshinori Masaoka Takaaki Shishido Kengo Yamamoto Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up Journal of Orthopaedic Surgery and Research Adverse local tissue reaction ALTR Pseudotumor Total hip arthroplasty Polyethylene wear Metal-on-polyethylene |
| title | Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up |
| title_full | Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up |
| title_fullStr | Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up |
| title_full_unstemmed | Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up |
| title_short | Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up |
| title_sort | do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty a minimum 15 year follow up |
| topic | Adverse local tissue reaction ALTR Pseudotumor Total hip arthroplasty Polyethylene wear Metal-on-polyethylene |
| url | https://doi.org/10.1186/s13018-023-03634-7 |
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