Kraemer W J, Maistrelli G L, Fornasier V, Binnington A, Zhao J F
Department of Orthopaedic Surgery, Toronto East General and Orthopaedic Hospital, Ontario, Canada.
J Appl Biomater. 1995 Winter;6(4):225-30. doi: 10.1002/jab.770060402.
The distal migration of polyethylene wear debris appears to be a major cause of loosening and osteolysis of cementless total hip arthroplasties. The use of modern cementing techniques, circumferential porous or hydroxyapatite (HA) coating has been advocated as a means of preventing access of the particles to the bone-implant interface. The purpose of this study was to compare the ability of different methods of implant fixation to prevent wear debris migration. Three each of smooth, porous-coated, HA-coated, and cemented hemiarthroplasties were implanted in the right hip of 12 dogs. Polyethylene particles were injected into the hip once a month for 4 months and then the femurs were sectioned. The percentage bone ingrowth was 8% for the smooth, 38% for the porous, and 83% for the HA-coated sections. Infiltration of the interface membrane by histiocytes containing polyethylene particles, and endosteal scalloping or osteolysis were found on all sections of the smooth prostheses. No particles or osteolysis were found on any sections of the other three types of prostheses. Capsular and lymph node sections from all dogs revealed histiocytic infiltration with numerous polyethylene particles present. It is concluded that the use of cement, porous, or HA coating prevents or delays access of the polyethylene wear debris to the bone-implant interface. No one of these methods of fixation proved more advantageous in the 5-month limit of this study.
聚乙烯磨损颗粒的远端迁移似乎是无骨水泥全髋关节置换术松动和骨溶解的主要原因。现代骨水泥技术、环形多孔或羟基磷灰石（HA）涂层的应用已被提倡作为防止颗粒进入骨-植入物界面的一种手段。本研究的目的是比较不同植入物固定方法防止磨损颗粒迁移的能力。将光滑的、多孔涂层的、HA涂层的和骨水泥半关节置换假体各三个植入12只狗的右髋关节。每月向髋关节内注射一次聚乙烯颗粒，持续4个月，然后将股骨切片。光滑假体切片的骨长入百分比为8%，多孔假体为38%，HA涂层假体为83%。在光滑假体的所有切片上均发现含有聚乙烯颗粒的组织细胞浸润界面膜，以及骨内膜扇贝样改变或骨溶解。在其他三种类型假体的任何切片上均未发现颗粒或骨溶解。所有狗的关节囊和淋巴结切片均显示有组织细胞浸润，存在大量聚乙烯颗粒。得出的结论是，使用骨水泥、多孔涂层或HA涂层可防止或延迟聚乙烯磨损颗粒进入骨-植入物界面。在本研究5个月的时限内，这些固定方法中没有一种被证明更具优势。
