Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up

Tsunehito Ishida; Toshiyuki Tateiwa; Yasuhito Takahashi; Toshinori Masaoka; Takaaki Shishido; Kengo Yamamoto

doi:10.1186/s13018-023-03634-7

Do polyethylene wear particles affect the development of pseudotumor in total hip arthroplasty? A minimum 15-year follow-up

J Orthop Surg Res. 2023 Feb 28;18(1):147. doi: 10.1186/s13018-023-03634-7.

Authors

Tsunehito Ishida¹, Toshiyuki Tateiwa², Yasuhito Takahashi^{3

4}, Toshinori Masaoka², Takaaki Shishido², Kengo Yamamoto²

Affiliations

¹ Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan. tsune725@aol.com.
² Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
³ Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan. yasuhito@tokyo-med.ac.jp.
⁴ Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan. yasuhito@tokyo-med.ac.jp.

Abstract

Background: Adverse local tissue reactions have been problematic as an implant-related complication in total hip arthroplasty (THA). Despite the absence of significant metal wear and corrosion, granulomatous pseudotumor has been reported to be caused by polyethylene wear. We performed a long-term follow-up study investigating the relationship between polyethylene wear and pseudotumor formation in THA.

Methods: This study included 57 patients (64 hips) that underwent primary THA with metal-on-polyethylene or ceramic-on-polyethylene bearing over a minimum follow-up of 15 years. They were stratified into pseudotumor and non-pseudotumor groups and their linear wear rates of polyethylene liner and serum cobalt (Co) and chromium (Cr) ion levels were compared. Pseudotumor was diagnosed on metal artifact reduction sequence-MRI according to its composition and wall thickness using the Hauptfleisch classification.

Results: The incidence of pseudotumor was 34% (22/64 hips) at the mean follow-up of 16.9 years. Metal ion levels did not differ between the pseudotumor and non-pseudotumor groups, and none of the patients exceeded the Co/Cr ratio of 2.0 μg/L. Moreover, the wear rate in the pseudotumor group was 1.8 times greater than in the non-pseudotumor group (0.14 vs. 0.08 mm/year, P < 0.001). According to an analysis of the receiver operating characteristic curves, the cutoff level of the wear rate to discriminate between pseudotumor and non-pseudotumor patients at 15 years was 0.11 mm/year (area under the curve = 91%; sensitivity = 95%; specificity = 78%; accuracy = 87%).

Conclusions: Our results might provide new insights into excessive polyethylene wear potentially leading to the future development of both pseudotumor and osteolysis. Further studies are needed to clarify the direct relationship between polyethylene wear and pseudotumor and the mutual effects of osteolysis and pseudotumor in particle reactions.

Keywords: ALTR; Adverse local tissue reaction; Ceramic-on-polyethylene; Metal-on-polyethylene; Polyethylene wear; Pseudotumor; Total hip arthroplasty.

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Ceramics
Follow-Up Studies
Humans
Osteolysis*
Polyethylene / adverse effects
Postoperative Complications

Substances

Polyethylene