Histopathological Analysis of PEEK Wear Particle Effects on the Synovial Tissue of Patients

Introduction. Increasing interest developed in the use of carbon-fiber-reinforced-poly-ether-ether-ketones (CFR-PEEK) as an alternative bearing material in knee arthroplasty. The effects of CFR-PEEK wear in in vitro and animal studies are controversially discussed, as there are no data available concerning human tissue. The aim of this study was to analyze human tissue containing CFR-PEEK as well as UHMWPE wear debris. The authors hypothesized no difference between the used biomaterials. Methods and Materials. In 10 patients during knee revision surgery of a rotating-hinge-knee-implant-design, synovial tissue samples were achieved (tibial inserts: UHMWPE; bushings and flanges: CFR-PEEK). One additional patient received revision surgery without any PEEK components as a control. The tissue was paraffin-embedded, sliced into 2 μm thick sections, and stained with hematoxylin and eosin in a standard process. A modified panoptical staining was also done. Results. A “wear-type” reaction was seen in the testing and the control group. In all samples, the UHMWPE particles were scattered in the tissue or incorporated in giant cells. CFR-PEEK particles were seen as conglomerates and only could be found next to vessels. CFR-PEEK particles showed no giant-cell reactions. In conclusion, the hypothesis has to be rejected. UHMWPE and PEEK showed a different scatter-behavior in human synovial tissue.

[1]  A Unsworth,et al.  Wear studies on the likely performance of CFR-PEEK/CoCrMo for use as artificial joint bearing materials , 2009, Journal of materials science. Materials in medicine.

[2]  L. Frommelt,et al.  Proposal for a histopathological consensus classification of the periprosthetic interface membrane , 2006, Journal of Clinical Pathology.

[3]  J Fisher,et al.  Polyethylene particles of a 'critical size' are necessary for the induction of cytokines by macrophages in vitro. , 1998, Biomaterials.

[4]  P. Revell,et al.  The combined role of wear particles, macrophages and lymphocytes in the loosening of total joint prostheses , 2008, Journal of The Royal Society Interface.

[5]  M. Grant,et al.  In vitro biocompatibility testing of polymers for orthopaedic implants using cultured fibroblasts and osteoblasts. , 1995, Biomaterials.

[6]  J. Jacobs,et al.  Biologic effects of implant debris. , 2009, Bulletin of the NYU hospital for joint diseases.

[7]  C. Rivard,et al.  In vivo biocompatibility testing of peek polymer for a spinal implant system: a study in rabbits. , 2002, Journal of biomedical materials research.

[8]  V. Jansson,et al.  Inflammatory response against different carbon fiber-reinforced PEEK wear particles compared with UHMWPE in vivo. , 2010, Acta biomaterialia.

[9]  T. Albert,et al.  Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation. , 2009, The spine journal : official journal of the North American Spine Society.

[10]  D. Chappard,et al.  Migration of wear debris of polyethylene depends on bone microarchitecture. , 2009, Journal of biomedical materials research. Part B, Applied biomaterials.

[11]  N. Rushton,et al.  Pre-clinical studies to validate the MITCH PCR™ Cup: a flexible and anatomically shaped acetabular component with novel bearing characteristics , 2008, Journal of materials science. Materials in medicine.

[12]  Hollis G Potter,et al.  The cellular and molecular biology of periprosthetic osteolysis. , 2007, Clinical orthopaedics and related research.

[13]  A. Turner,et al.  Polyetheretherketone as a biomaterial for spinal applications. , 2006, Biomaterials.

[14]  M. Péoc'h,et al.  Dissemination of Wear Particles to the Liver, Spleen, and Abdominal Lymph Nodes of Patients with Hip or Knee Replacement* , 2000, The Journal of bone and joint surgery. American volume.

[15]  V. Jansson,et al.  Elevated cytokine expression of different PEEK wear particles compared to UHMWPE in vivo , 2013, Journal of Materials Science: Materials in Medicine.

[16]  B. Moretti,et al.  Hydroxyapatite coated with hepatocyte growth factor (HGF) stimulates human osteoblasts in vitro , 2000 .

[17]  C. Kaddick,et al.  Biotribology of a new bearing material combination in a rotating hinge knee articulation. , 2013, Acta biomaterialia.

[18]  J. Fisher,et al.  Biological reactions to wear debris in total joint replacement , 2000, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[19]  M. Wimmer,et al.  [Systemic spread of wear debris--an in-vivo study]. , 2006, Zeitschrift fur Orthopadie und ihre Grenzgebiete.

[20]  J. Fisher,et al.  Effect of size and dose on bone resorption activity of macrophages by in vitro clinically relevant ultra high molecular weight polyethylene particles. , 2000, Journal of biomedical materials research.

[21]  M. G. Krukemeyer,et al.  Revised histopathological consensus classification of joint implant related pathology. , 2014, Pathology, research and practice.

[22]  O. Muratoglu,et al.  Vitamin E diffused, highly crosslinked UHMWPE: a review , 2011, International Orthopaedics.

[23]  J. Galante,et al.  Macrophage/particle interactions: effect of size, composition and surface area. , 1994, Journal of biomedical materials research.

[24]  T. Bauer,et al.  Biological response to chopped-carbon-fiber-reinforced peek. , 1992, Journal of biomedical materials research.

[25]  B. Wroblewski,et al.  Evaluation of the response of primary human peripheral blood mononuclear phagocytes to challenge with in vitro generated clinically relevant UHMWPE particles of known size and dose. , 2000, Journal of biomedical materials research.

[26]  J. Fisher,et al.  Biological response to wear debris generated in carbon based composites as potential bearing surfaces for artificial hip joints. , 2003, Journal of biomedical materials research. Part B, Applied biomaterials.

[27]  C. Schröder,et al.  Biotribology of alternative bearing materials for unicompartmental knee arthroplasty. , 2010, Acta biomaterialia.

[28]  D. Chappard,et al.  Migration of polyethylene particles around nonloosened cemented femoral components from a total hip arthroplasty-an autopsy study. , 2004, Journal of biomedical materials research. Part B, Applied biomaterials.