Abstract：
The use of highly crosslinked ultra-high molecular weight polyethylene (XLPE) has significantly reduced the volumetric wear of acetabular liners, thereby reducing the incidence of osteolysis. However, contemporary components tend to generate smaller wear particles, which can no longer be identified using conventional histology. This technical limitation can result in imprecise diagnosis. Here, we report on two uncemented total hip arthroplasty cases (~7 years in situ) revised for periprosthetic fracture of the femur and femoral loosening, respectively. Both liners exhibited prominent wear. The retrieved pseudocapsular tissue exhibited a strong macrophage infiltration without microscopically identifiable polyethylene particles. Yet, using Fourier-transform infrared micro-spectroscopic imaging (FTIR-I), we demonstrated the prominent intracellular accumulation of polyethylene debris in both cases. This study shows that particle induced osteolysis can still occur with XLPE liners, even under 10 years in situ. Furthermore, we demonstrate the difficulty of determining the presence of polyethylene debris within periprosthetic tissue. Considering the potentially increased bioactivity of finer particles from XLPE compared to conventional liners, an accurate detection method is required, and new histopathological hallmarks of particle induced osteolysis are needed. FTIR-I is a great tool to that end and can help the accurate determination of foreign body tissue responses.
摘要：
使用高度交联的超高分子量聚乙烯（XLPE）显着降低了髋臼衬里的体积磨损，从而降低骨质溶解的发生率。然而,当代部件倾向于产生较小的磨损颗粒，无法再使用常规组织学识别。这种技术限制可能导致不精确的诊断。这里,我们报告了2例因股骨假体周围骨折和股骨松动而修订的非骨水泥全髋关节置换术（原位约7年），分别。两种衬垫均表现出明显的磨损。回收的假胶囊组织表现出强烈的巨噬细胞浸润，没有显微镜可识别的聚乙烯颗粒。然而，利用傅里叶变换红外显微光谱成像(FTIR-I),在这两种情况下，我们都证明了聚乙烯碎片的显着细胞内积累。这项研究表明，颗粒诱导的骨质溶解仍然可以发生与XLPE衬垫，甚至在原地不到10年。此外，我们证明了确定假体周围组织中聚乙烯碎片存在的困难。考虑到XLPE较细颗粒的生物活性可能会增加，与常规衬里相比，需要一种精确的检测方法，需要颗粒诱导的骨质溶解的新组织病理学标志。FTIR-I是一个很好的工具，可以帮助准确确定异物组织的反应。
