Are Periprosthetic Tissue Reactions Observed After Revision of Total Disc Replacement Comparable to the Reactions Observed After Total Hip or Knee Revision Surgery?
Are Periprosthetic Tissue Reactions Observed After Revision of Total Disc Replacement Comparable to the Reactions Observed After Total Hip or Knee Revision Surgery?
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DOI：
10.1097/brs.0b013e3182154c22
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发表时间：
2012-01-15
期刊：
影响因子：
3
通讯作者：
van Ooij, Andre
中科院分区：
文献类型：
--
作者：
Punt, Ilona M.;Austen, Shennah;van Ooij, Andre
研究设计。比较研究。目的。比较全椎间盘置换术 (TDR)、全髋关节置换术 (THA) 和全膝关节置换术 (TKA) 翻修手术后观察到的假体周围组织反应。背景数据摘要。全髋关节置换 (THA) 和全膝关节置换 (TKA) 后经常观察到假体磨损碎片导致颗粒病，进而导致骨质溶解。尽管最近已证实 TDR 后存在聚乙烯 (PE) 颗粒和假体周围炎症，但很少观察到骨溶解。脊柱中 PE 磨损碎片的临床相关性仍知之甚少。方法。比较 CHARITE TDR (n - 22)、THA (n - 10) 和 TKA (n = 4) 翻修手术期间回收的 PE 颗粒的数量、大小和形状，以及假体周围组织中炎症细胞的数量和类型。组织样本用苏木精/伊红染色，并使用明场和偏振光的光学显微镜检查。结果。 THA后观察到大量小于6μm的PE颗粒，主要被巨噬细胞吞噬。 TKA 组的尺寸范围较广，有许多较大的 PE 颗粒和更多的巨细胞。在 TDR 中，尺寸范围与 TKA 中观察到的相似。然而，最小的颗粒最为普遍，75% 的颗粒小于 6 μm，如修订版 THA 中所示。在TDR中，巨噬细胞和巨细胞都存在，巨噬细胞数量较多。结论。 TDR 修正手术后，小和大的 PE 颗粒都存在，与 THA 和 TKA 磨损模式兼容。不同组假体周围组织反应之间的相似性可能有助于更深入地了解腰椎中 PE 颗粒和炎症细胞的临床相关性。目前的研究结果可能有助于改进 TDR 设计，应用先前在 THA 和 TKA 中开发的技术，以实现 TDR 更长的生存期。
Study Design. Comparative study.Objective. To compare periprosthetic tissue reactions observed after total disc replacement (TDR), total hip arthroplasty (THA), and total knee arthroplasty (TKA) revision surgery.Summary of Background Data. Prosthetic wear debris leading to particle disease, followed by osteolysis, is often observed after THA and TKA. Although the presence of polyethylene (PE) particles and periprosthetic inflammation after TDR has been proven recently, osteolysis is rarely observed. The clinical relevance of PE wear debris in the spine remains poorly understood.Methods. The number, size, and shape of PE particles, as well as quantity and type of inflammatory cells in periprosthetic tissue retrieved during CHARITE TDR (n - 22), THA (n - 10), and TKA (n = 4) revision surgery were compared. Tissue samples were stained with hematoxylin/eosin and examined by using light microscopy with bright field and polarized light.Results. After THA, large numbers of PE particles of size less than 6 mu m were observed, which were mainly phagocytosed by macrophages. The TKA group had a broad size range with many larger PE particles and more giant cells. In TDR, the size range was similar to that observed in TKA. However, the smallest particles were the most prevalent with 75% of the particles being less than 6 mu m, as seen in revision THA. In TDR, both macrophages and giant cells were present with a higher number of macrophages.Conclusion. Both small and large PE particles are present after TDR revision surgery compatible with both THA and TKA wear patterns. The similarities between periprosthetic tissue reactions in the different groups may give more insight into the clinical relevance of PE particles and inflammatory cells in the lumbar spine. The current findings may help to improve TDR design as applied from technologies previously developed in THA and TKA with the goal of a longer survival of TDR.