These authors examined retrieved anatomic (aTSAs n=11) and reverse ( rTSAs n=12) shoulder arthroplasties to determine the extent of implant damage and to characterize the nature of the responses of the periprosthetic tissues.
The polyethylene bearing surfaces of aTSAs were dominated by three body wear and plastic deformation, whereas the rTSA PE components exhibited mainly polishing and scratching.
In both groups the primary nature of the inflammatory response was a moderate to marked macrophage response to wear particles (78% of cases). The particle-laden macrophages tended to occur in broad sheets and contained metal, PE, bone cement and suture debris.
The extent of macrophage and foreign body giant cell responses was greater in the aTSA group.
Metal particles were seen in 63% of aTSAs and 83% of rTSAs.
In the aTSA group, bone cement was seen in all cases and suture was observed in 9 cases,
A mild lymphocyte response and chromium-phosphate debris was present within the tissue of a aTSA case with marked corrosion, which may be indicative of an early stage adverse local tissue reaction.
Comment: This work demonstrates that shoulder arthroplasties shed debris: PE, metal, bone cement and suture and that this debris can stimulate a substantial macrophage response. We surely need to learn more about particulate disease in the shoulder, not only with respect to its role in implant failure, but also its role in shoulders that are unexpectedly symptomatic post arthroplasty.
Comment: This work demonstrates that shoulder arthroplasties shed debris: PE, metal, bone cement and suture and that this debris can stimulate a substantial macrophage response. We surely need to learn more about particulate disease in the shoulder, not only with respect to its role in implant failure, but also its role in shoulders that are unexpectedly symptomatic post arthroplasty.
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