Piñol Ignasi, Torres Alberto, Gil Gabriel, Prats Eva, Puig-Verdier Lluis, Hinarejos Pedro
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
Knee. 2014 Mar;21(2):402-5. doi: 10.1016/j.knee.2013.10.013. Epub 2013 Oct 31.
One of the most frequent reasons for total knee arthroplasty late failure is osteolysis. It has been related to foreign body reaction to polyethylene particles. The aim of this study is to analyse the number, size and morphology of polyethylene particles in synovial fluid in total knee arthroplasty revision and correlate them to the pathology and the degree of osteolysis.
Synovial fluid was obtained in 12 patients before the revision total knee arthroplasty. Polyethylene particles were isolated and analysed through scanning electron microscopy. Samples of synovial tissue were analysed with optical microscopy while considering the parameters of particles and histiocytic infiltration. Osteolysis was analysed with plain radiography and the macroscopic aspect during surgery.
The statistical analysis showed a significant correlation between a high concentration of polyethylene particles in synovial fluid and a high degree of osteolysis. The concentration of particles in synovial fluid also showed a significant correlation with a high degree of particles and histiocytes in the histological analysis. There was a relationship between the size of particles and the degree of osteolysis. No relationship was found between the shape of the particles and the histological findings or the degree of osteolysis.
In an "in vivo" TKA scenario, the presence of a high concentration of polyethylene particles in the synovial fluid seems to be the cause of a highly active foreign body histological reaction, with an increased number of histiocytes, which seems to be the cause of a significant degree of osteolysis around the implant.
全膝关节置换术晚期失败最常见的原因之一是骨溶解。它与对聚乙烯颗粒的异物反应有关。本研究的目的是分析全膝关节置换术翻修术中滑液中聚乙烯颗粒的数量、大小和形态，并将它们与病理情况及骨溶解程度相关联。
在12例患者进行全膝关节置换术翻修术前获取滑液。通过扫描电子显微镜分离并分析聚乙烯颗粒。对滑膜组织样本进行光学显微镜分析，同时考虑颗粒和组织细胞浸润的参数。通过X线平片和手术中的宏观情况分析骨溶解。
统计分析显示，滑液中聚乙烯颗粒的高浓度与高度骨溶解之间存在显著相关性。滑液中颗粒的浓度在组织学分析中也与高颗粒度和组织细胞显示出显著相关性。颗粒大小与骨溶解程度之间存在关联。未发现颗粒形状与组织学结果或骨溶解程度之间存在关联。
在“体内”全膝关节置换的情况下，滑液中高浓度聚乙烯颗粒的存在似乎是导致高度活跃的异物组织学反应的原因，组织细胞数量增加，这似乎是植入物周围显著骨溶解的原因。
